Leistungsbilanz der Inselzellen nach Pankreasgangocclusion ? ein Langzeitversuch

Abstract

The transduodenal occlusion of the pancreatic duct with Prolamin (Ethibloc) was carried out in an experiment with 38 Göttinger minipigs. Occlusion of the pancreatic duct leads to selective atrophy of the excretory pancreatic parenchyma. Up until now it has not been clear whether the endocrine functional capacity of the gland stays intact in a long-term experiment or whether the islands of Langerhans are also altered by the pancreatic duct occlusion. The following tests were carried out by us to determine the endocrine status: 1. Intravenous glucose tolerance test (i.v. GTT); 2. Glucose assimilation analysis after CONARD (K-value); 3. Insulin analysis during i.v. GTT; 4. Intravenous Tolbutamid test. Twelve months after the occlusion, reduced glucose tolerance and a reduction in insulin secretion were detected in the intravenous glucose tolerance test. Glucose assimilation (K-value) was not changed significantly. Fasting blood sugar and basic insulin level remained unchanged. Only a small blood-sugar decrease was measured after selective B-cell stimulation with Tolbutamid. The fibrosclerosis produced by the occlusion of the pancreatic duct with Prolamin also seemed to attack the cells of the islands and lead to their partial destruction.

Prospective Randomized Comparison between a New Mattress Technique and Cattell (duct‐to‐mucosa) Pancreaticojejunostomy for Pancreatic Resection

“…Anastomotic dehiscence with consecutive peritonitis occurs in up to 20% of the cases, even in recent studies [4][5][6][7]. To protect the pancreatic anastomosis, several perioperative measures have been proposed: duct liga-tion [8,9], duct occlusion with prolamin [10] or fibrin glue [11][12][13], administration of the somatostatin analogue octreotide to inhibit production of pancreatic juice [14,15], drainage techniques such as external drainage of the jejunal loop [16,17], internal stenting of the pancreatic duct [18,19], external drainage of the pancreatic duct [20][21][22], or a variety of technical modifications of the pancreatojejunal anastomoses [23,24]. Furthermore, the choice of suture material differs from center to center, and non-absorbable, as well as absorbable sutures, or both types combined, are employed [28,29,35,36].…”