Đánh giá chức năng tiết ngoại của tuyến tụy sau phẫu thuật cắt toàn bộ tuyến tụy tá tràng

Springer Science and Business Media LLC - Tập 10 - Trang 258-267 - 2019
Kiran Thogari1, Mallika Tewari1, S. K. Shukla2, S. P. Mishra3, H. S. Shukla1
1Division of Hepatopancreatobiliary and GastroIntestinal Oncology, Department of Surgical Oncology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
2Department of Gastroenterology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
3Department of Biochemistry, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India

Tóm tắt

Suy tuyến tụy ngoại tiết (PEI) là một biến chứng lâu dài phổ biến sau phẫu thuật cắt toàn bộ tuyến tụy tá tràng (PD) và được quan sát thấy ở 23–80% bệnh nhân. Khi tỷ lệ tử vong sau phẫu thuật PD đã giảm đáng kể, điều này yêu cầu chú ý hơn đến việc chẩn đoán và điều trị các hậu quả chức năng lâu dài sau PD. Những hậu quả này bao gồm PEI và suy nội tiết tố có thể dẫn đến suy dinh dưỡng nghiêm trọng và thường ảnh hưởng tiêu cực đến chất lượng cuộc sống (QOL) của bệnh nhân. Một tìm kiếm trên PubMed đã được thực hiện cho các bài báo sử dụng các từ khóa “suy tuyến tụy ngoại tiết”; “phẫu thuật cắt toàn bộ tuyến tụy tá tràng”; “chất lượng cuộc sống sau phẫu thuật cắt toàn bộ tuyến tụy tá tràng”; “elastase phân”; “các xét nghiệm trực tiếp, gián tiếp cho suy tuyến tụy ngoại tiết”; “liệu pháp thay thế enzyme tụy.” Các nghiên cứu liên quan đã được rút gọn và phân tích. Bài viết này tóm tắt các nghiên cứu liên quan đến PEI sau PD. Chúng tôi cũng thảo luận về các thay đổi chức năng sau PD, các yếu tố nguy cơ và yếu tố dự đoán cho PEI sau phẫu thuật, triệu chứng lâm sàng, các xét nghiệm trực tiếp và gián tiếp để xác định PEI, liệu pháp thay thế enzyme tụy (PERT), và QOL sau phẫu thuật cắt bỏ tuyến tụy do ung thư. Kết quả cho thấy PEI nghiêm trọng xảy ra ở hầu hết bệnh nhân sau PD. Xét nghiệm elastase phân 1 là một xét nghiệm gián tiếp dễ thực hiện và nên được thực hiện thường xuyên ở cả bệnh nhân có triệu chứng và không có triệu chứng sau PD. Cần cân nhắc PERT ở mọi bệnh nhân sau PD với mục tiêu cải thiện QOL và có thể cả sự sống lâu dài của họ.

Từ khóa

#Suy tuyến tụy ngoại tiết #Phẫu thuật cắt toàn bộ tuyến tụy tá tràng #Chất lượng cuộc sống #Elastase phân #Xét nghiệm cho suy tuyến tụy ngoại tiết #Liệu pháp thay thế enzyme tụy.

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