| Background and objectivePancreatic tumors are common tumors of the digestive tract, and the incidence of the diseases rises in recent years. The most common malignant tumor is pancreatic cancer, whose overall five-year survival rate is less than 1% . Each year, the number of patients died by Panceatic cancer is the forth largest of counterpart by all sorts of cancers in the world, which seriously threatens to human health. Surgical resection is the main treatment for pancreatic cancer. It has been nearly seventy years since Whipple did the first pancreatoduodenectomy in the thirties of last century and human beings has done deep research on surgical treatment of pancreatic cancer. However, pancreaticoduodenectomy(PD) and distal pancreatectomy(DP) are still the most common surgical procedures. The patients with pancreatic endocrine tumors, such as insulinoma, glucagonoma, somatostatinoma and other tumors, no doubt, after surgery can significantly improve their symptoms. For those wiht exocrine tumors, such as cystic tumors, pancreatic cancer, etc, the effects of different surgical interventions on glucose metabolism are poorly known. The purpose of this research: design prospectie layered scheme, and discuss the effects of varied surgical treatments on glucose homeostasis and insulin secretion by monitoring the changes of glucose metabolism indexes.MethodsPerspective study on 120 patients from 2009.11.01 to 2010.10.31 was done and all patients were subdivided into two groups: (1) patients with pancreatic cancer (n=60, PC group). 36 (60%) patients were treated by pancreaticoduodenectomy (PD), whereas 24 patient (40%) were treated by distal pancreatectomy(DP); (2) patients with benign pancreatic tumor (n=60, BPT group). 21 patient (35%) were treated by PD, whereas 39 (65%) patients were treated by DP. All patients were with the removal of approximately 40% pancreatic parenchyma and examined in the morning before and after pancreatic surgery(the 1st, 3rd , 5th , 7th and 30th day since operation) to obtain the plasma concentration of fasting glucose, HbA1c, fasting insulin and C-peptide.ResultsPreoperative fasting glucose concentrations were 6.50±1.67mmol/L mmol/l in patients with pancreatic cancer, and 5.42±0.81 mmol/L in patients with benign pancreatic tumor. Preoperative fasting glucose elicited a significant rise in pancreatic carcinomas(p<0.05). Preoperative glycated hemoglobin concentrations were 6.17±1.45(%) in patients with pancreatic carcinomas, and 5.40±1.36(%) in patients with benign pancreatic tumors. The former was higher. Preoperative insulin concentrations of two groups were 6.76±3.08mU/L and 6.59±2.61mU/L. Preoperative C-peptide concentrations of two groups were 1.51±0.65ug/L and 1.62±0.71 ug/L. The p values were above 0.05. The postoperative fasting glucose concentration were significantly higher in patients with benign pancreatic tumors. Partial pancreatectomy led to a reduction in insulin secretion by 39% in carcinoma patients and 38% in benign pancreatic tumor patients(p<0.05). Nevertheless, fasting glucose concentrations in patients with pancreatic cancer were ameliorated after pancreaticoduodenectomy (p<0.05), espically in patients with pancreatic cancer and diabetes mellitus. However distal pancreatectomy increased fasting glucose concentration in patients with benign pancreatic tumor (p<0.05) .ConclusionsInsulin secretion in patients with pancreatic tumor was diminished because of the reduction of reduction of pancreatic parenchyma after partical pancreatectomy. However, the reduction of fasting insulin concentration was not consistent with the increase of fasting glucose concentration. When pancreatic cancer was removed by surgery, blood glucose concentration would be ameliorated and insulin sensitivity would be improved. The glycometabolic effects after varied surgical treatments of pancreatic tumors were different. Pancreaticoduodenectomy can ameliorate glycometabolism, especially in patients with pancreatic cancer. |
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