Bedeutung des Erhalts der gastroduodenalen Passage auf die intestino-insulinäre Achse und den Glucose-Metabolismus in der chirurgischen Therapie der chronischen Pankreatitis

Abstract

Background: In chronic pancreatitis (CP) classical resection, i.e. partial pancreatoduodenectomy (PD) according to Whipple, includes resection of the distal stomach and duodenum. Duodenum-preserving resection of the head of the pancreas (DPRHP) and local pancreatic head excision with longitudinal pancreaticojejunostomy (LPHE-LPJ) preserve gastrointestinal (GI) transit. The aim of this study was to analyse the impact of preserving the GI transit on the entero-insulinar axis and glucose metabolism by measuring of glucose, insulin (INS), C-peptide (C-PEP) and glucagon (GLU). Patients and methods: In a prospective randomized trial 28 patients suffering from CP underwent either PD (n = 8), DPRHP (n = 10) or LPHE-LPJ (n = 10). Prior to and 6 months after surgery, serum concentrations of glucose, INS, C-PEP and GLU were determined before and after standardized test meal stimulation (550 ml, 1062 kcal). Seven healthy subjects served as controls. Results: Prior to surgery glucose increased from 99.8 to 148 mg/dl (p < 0.01), INS from 9.4 to 75 uE/ml (p < 0.01), C-PEP from 2 to 9.2 ng/ml (p < 0.01), and GLU from 125 to 267 uE/ml (p < 0.05) in CP patients after stimulation. Six months after surgery, in the PD group the rise of glucose from 107 to 242 mg/dl was delayed. After DPRHP the glucose concentration rose from 106 to 246 mg/dl, and after LPHE-LPJ from 92 to 206 mg/dl. In the PD group the INS concentration rose from 5.2 to 45 uE/ml. After DPRHP INS increased from 6.8 to 46 uE/ml and after LPHE-LPJ from 8.9 to 49 uE/ml. In the PD group C-PEP increased from 1.5 to 9.1 ng/ml. After DPRHP C-PEP rose from 1.3 to 7.9 ng/ml, and after LPHE-LPJ from 1.2 to 8.6 ng/ml. In the PD group GLU increased from 157 to 570 uE/ml, after DPRHP GLU increased from 175 to 379 uE/ml, and after LPHE-LPJ fom 153 to 416 uE/ml. Conclusions: Preservation of the GI transit by DPRHP and LPHE-LPJ reduces the secretion of GLU in comparison to PD. Glucose, INS and C-PEP secretion is not significantly influenced by the GI transit.