Quantitative Evaluation Of The Relationship Between Pancreatic Resection Volume Of Benign Pancreatic Diseases And Postoperative Hyperglycemia Based On CT

Objective The maintenance of pancreatic function after partial pancreatectomy has become a new therapeutic challenge.In this study,the pancreatic resection volume was measured by CT imaging to evaluate the relationship between pancreatic parenchyma loss and early postoperative hyperglycemia in patients with benign pancreatic diseases.Methods According to the inclusion and exclusion criteria,a total of 171 patients with benign pancreatic tumors or intractable chronic pancreatitis,whose preoperative fasting blood glucose(FBG)was normal and who underwent partial pancreatectomy were reviewed.The pancreatic volume was measured by CT imaging one week before surgery and two weeks after surgery.The pancreatic volume before and after surgery was measured by CT imaging to calculate the pancreatic resection volume ratios(PRV).According to their different PRV,171 patients were divided into five groups: < 30%,30% ~ 39%,40% ~ 49%,50% ~ 59% and ≥ 60%.The correlation between the PRV and postoperative FBG was investigated.According to the postoperative FBG value,the patients were divided into a hyperglycemia group(HG group)and nonhyperglycemia group(non-HG group)to explore the best cutoff value of the PRV between the two groups.Results(1)The blood glucose level of benign pancreatic diseases within 2 weeks after operation was higher than that before operation(P<0.001).(2)There were significant differences in the postoperative FBG among the five groups: PRV < 30%,30% ~ 39%,40% ~ 49%,50% ~ 59% and ≥ 60%(P<0.001).(3)The PRV was positively correlated with postoperative FBG in the benign tumor group and chronic pancreatitis group(R = 0.727 and R = 0.651,P<0.001).(4)ROC curve analysis showed that the best cutoff value of the PRV between the HG(n = 84)and non-HG(n = 87)was 39.95% with an AUC = 0.898;the sensitivity was 89.29%,and the specificity was 82.76%.Conclusion There was a linear positive correlation between the postoperative FBG level and PRV.Patients with a PRV ≥ 40% are more likely to develop early postoperative hyperglycemia.Objective After partial pancreatectomy,the loss of pancreatic parenchyma must mean the loss of endocrine cells and function,but the compensatory ability of pancreas has not been reached.The purpose of this study was to explore the relationship between pancreatic parenchyma loss and type 3c diabetes mellitus(T3c DM).Methods According to the inclusion and exclusion criteria,a total of 105 patients with benign pancreatic tumors or chronic pancreatitis,whose preoperative fasting blood glucose(FBG)was normal and who underwent partial pancreatectomy were included.The pancreatic resection volume ratios(PRV)was measured by CT imaging.The patients were followed up for 18 months(3 months,6 months,9 months,12 months and 18 months after operation).The content of the follow-up was the fasting blood glucose value of the patients.According to WHO criteria,patients were divided into diabetes mellitus group(DM group),impaired fasting blood glucose group(IFG group)and normal blood glucose group(NG group).The differences of blood glucose at different time points after operation in the three groups were compared.The sex,age,BMI,hypertension,hyperlipidemia,surgery type were compared between non-diabetic group(non-DM group)and DM group.Exploring the best cutoff value of resection volume ratio to predict new-onset diabetes after operation.Results(1)A total of 13 patients with new-onset diabetes mellitus were found during the 18-month observation period,and the incidence was 12.38%(13/105).(2)The blood glucose of NG group returned to normal 3 months after operation.The blood glucose of the IFG group and the DM group also decreased 3 months after operation,but it was still higher than normal value.There was no significant difference between the FBG at 6,9,12 and 18 months postoperatively and those at 3 months postoperatively in the three groups(P > 0.05).(3)There was significant difference in age and PRV between non-DM group and DM group(P<0.05),and there was no significant difference in sex,hypertension,hyperlipidemia,BMI,surgery type between the two groups(P(29)0.05).(4)ROC curve analysis showed the best cutoff value of the PRV between the DM group and non-DM group was 52.60%,AUC = 0.727,the sensitivity was 76.92%,and the specificity was 77.27%.Conclusion Patients with PRV ≥ 52.60% have a higher risk of developing T3 c DM after operation.In addition,age are also associated with postoperative diabetes mellitus.The occurrence of T3 c DM may be a multifactor process.Therefore,it is necessary to follow up the patients who have undergone partial pancreatectomy for a long time,especially the elderly patients whose PRV is greater than 52.60%.