PANCREATIC SURGERY, NOT PANCREATITIS, IS THE PRIMARY CAUSE OF DIABETES AFTER ACUTE FULMINANT PANCREATITIS

被引:25
作者
ERIKSSON, J [1 ]
DOEPEL, M [1 ]
WIDEN, E [1 ]
HALME, L [1 ]
EKSTRAND, A [1 ]
GROOP, L [1 ]
HOCKERSTEDT, K [1 ]
机构
[1] UNIV HELSINKI,CENT HOSP,DEPT SURG 4,HELSINKI,FINLAND
关键词
D O I
10.1136/gut.33.6.843
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Acute fulminant pancreatitis is associated with significant morbidity and mortality. To examine the outcome of conservative and surgical treatment of this disorder, 36 patients who survived an initial episode were restudied after a mean of six years. Fifty three per cent had developed diabetes mellitus, half of whom required insulin therapy. Pancreatic resection was associated with a 100% frequency of diabetes, while only 26% of those treated with peritoneal lavage developed this (p<0.001). Insulin secretion and sensitivity were assessed using the hyperglycaemic glucose clamp technique. First phase insulin secretion was impaired in surgically treated patients (mean (SEM) 14 (5)-mu-U/mlX10 minutes) compared with conservatively treated patients and control subjects (144 (66) and 87 (12)-mu-U/mlX10 minutes, respectively; p<0.05). Second phase and 'maximal' insulin secretion were also impaired among the surgically treated patients compared with the conservatively treated patients and the controls. Insulin sensitivity was reduced among the surgically treated patients (2.88 (58) mg/kg.minute) when compared with conservatively treated patients and healthy control subjects (5.87 (1.02) and 6.45 (0.66) mg/kg.minute; p<0.05). Pancreatic resection is associated with a very high frequency of diabetes compared with peritoneal lavage, and these results favour conservative treatment of active fulminant pancreatitis whenever possible.
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页码:843 / 847
页数:5
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共 31 条
  • [1] Alberti KGMM, 1988, INT C SERIES, V762, P211
  • [2] BAK M, 1988, INT C SERIES, V762, P239
  • [3] ROLE OF HYPERGLUCAGONEMIA IN MAINTENANCE OF INCREASED RATES OF HEPATIC GLUCOSE OUTPUT IN TYPE-II DIABETICS
    BARON, AD
    SCHAEFFER, L
    SHRAGG, P
    KOLTERMAN, OG
    [J]. DIABETES, 1987, 36 (03) : 274 - 283
  • [4] COOK DL, 1990, ELLENBERG RIFKINS DI, P2241
  • [5] DEFRONZO RA, 1979, AM J PHYSIOL, V237, pE214
  • [6] Diabetes mellitus, 1985, WHO TECHNICAL REPORT, V727
  • [7] DIXON WJ, 1985, BMDP STATISTICAL SOF
  • [8] THE THEORETICAL BASES OF INDIRECT CALORIMETRY - A REVIEW
    FERRANNINI, E
    [J]. METABOLISM-CLINICAL AND EXPERIMENTAL, 1988, 37 (03): : 287 - 301
  • [9] HOLLENDER LF, 1986, SURGICAL DISEASES PA, P450
  • [10] IHSE I, 1982, CONTROVERSIES ACUTE, P200