Langzeitergebnisse nach operativer Therapie der akuten hämorrhagisch-nekrotisierenden Pankreatitis

Abstract

A follow-up investigation of 20 patients, surgically treated for acute haemorrhagic necrotising pancreatitis, was performed in an average of 2 3/4 years after the operation. Twelve patients showed manifest diabetes mellitus, four further cases had a suspicious oral glucose tolerance test. Only one patient was insulin dependent. A secretin-pancreozymin test performed in 15 patients showed a dissociated or global pancreatic insufficiency in 13 cases. The extent of the endocrine and exocrine functional disturbance did not correlate with the extent of surgery. Postoperative functional defects were readily improved therapeutically in most cases. Only in patients who continued to consume alcohol were there digestive disturbances. The results indicate that the functional state of the remaining pancreas does not only depend on the extent of surgery but also on the extent of already existing or persisting toxic inflammatory damage and on the regenerative capacity of the remaining parenchyma.

Long-Term Outcome of Acute Necrohemorrhagic Pancreatitis

“…Since only 2 of these patients were sub mitted to left pancreatic resection, it seems that the damage to the insulae is more severe than to the exocrine tissue or, more likely, that the regeneration capacity of the endo crine structures is not as high as that of the acinar tissue. Anyway, the frequency of endo crine abnormalities in our subjects, submit ted to conservative surgery, is lower than the one observed by Dormeyer et al [23], These authors, in a follow-up study of 20 NHP patients submitted to surgical intervention, conservative in 6 and with partial pancreatic resection in 14. observed an altered endo crine function in 80% of them. These differ ent results could be ascribable to the more aggressive surgical policy of the German au thors, but the two studies do not allow a suf ficiently reliable comparison.…”

“…These differ ent results could be ascribable to the more aggressive surgical policy of the German au thors, but the two studies do not allow a suf ficiently reliable comparison. In fact, the pa tients followed up by Dormeyer et al [23] underwent a single checkup, performed at a very variable distance of time after discharge (between 18 months and 5 years).…”

Beta-Cell Function of the Pancreas after Necrotizing Pancreatitis

“…High prevalences (40–100%) of diabetes mellitus (DM) have been reported when pancreatic resection was performed to treat necrotizing pancreatitis [3, 4, 5]. More recent studies on the treatment of pancreatic necrosis using repeated necrosectomy and debridement have shown a much lower incidence of endocrine insufficiency [6, 7, 8].…”

Long-Term Outcome of Acute Pancreatitis: A Prospective Study with 118 Patients

“…Actually the Marseilles definition of AP seems to be acceptable for oedematous pancreatitis (AOP), because it is not likely that the severe parenchy mal damage characterizing the necrohaemorrhagic forms of AP (ANHP) would not leave morphological lesions except in a minority of cases. In fact, anatomical and/or functional abnormalities following ANHP have already been reported in different but never negligible percent ages by some authorities and ourselves [6][7][8][9][10]. These studies are generally based on a small number of cases, except for one series from West Germany [10] comprising Received: September 14.…”