A Clinical Study On Motilin And Gastrin Levels In Patient With Pancreatic Carcinoma And Periampullary Adenocarcinoma

PrefacePancreatic carcinoma and periampullary adenocarcinoma is one of the most fatal malignant disease today and rank fifth in cancer mortality worldwide. Surgical procedure is still the most effective treatment for the pancreatic and periampullary carcinoma, however, survival after surgery is lower and disapointing Codiv-illa' S PD opened up the surgical treatment of pancreatic carcinoma and periampullary adenocarcinoma . Since then, there have been two dominating kinds of operations those are whipple' s PD and Watson and longmire' s PPPD. Today PP-PD has developed as the primary operation of pancreatic carcinoma and periampullary adenocarcinoma. With the development of surgical operation, the postop-erational sysdromes was still very high, whereas, PD has been a safety and felicitous operation for pancreatic and periampullary carcinoma . There are four familiar postoperatinal sysdromes those are pancreatic fistula, gastrointestinal bleeding or abdominal bleeding, abdominal infection, DGE. The three fomer fatal postoper-ation has not regularly occurred. The occurrence of DGE is very high that prolong the day and expenditure in hospital, debase the existent quality of the patient. We should depress the occurrence of DGE in postoperation while we improve the operation. Therefore there is huge clinical significance and applied value for preventing and treatment of DGE in clinical investigation of PD. The investigation will discuss the clinical insignificance of dynamic transformation during PD to supply the acdemic foundation of postoperative gastrointestinal function improvement and treatment of DGE through measurement of gastrin and motilin during PD.Cases and Means53 (28 men,25 women) patients with a mean age of 54.60 (27-79) years who underwent SPD ,PPPD and Roux-en-y were studied. Two patients who died perioperation were excluded. 40(23men, 17women) health persons with a mean age of 57. 06 ( 39 ~ 75 ) years were coontrol group. Plasma motilin and serous gastrin in patients were measured by radioimmunoassay in properative 1 hour, postoperative 3~rdday,7~thday, 12~thday. So did healty persons. We note the time and blood transfusion of operation (BT) ,the variety of albumen,pathylogical types of the patients. We observed and noted the the totall output of nasogastric decompression during three postoperative days, The PH data of the gastrin liquid during operation, the peristaltic sound recovery timimg ( PSRT) and the anorectum exhaust timing ( AET) .Statistical AnalysisThe distribution of the baseline characteristics of patients and healthy persons were compared by using the chi-square test for enumeration data and binary variables.All tested measurement data agreed with standard normal distribution , so we use paired and unpaired T test for them.All analysis were run with the use of the Statistical Package of Social Science , version 11.5 ( SPSS11.5).Results1. The plasma motilin and serous gastrin in investigative group were much more than that in the control group.2. The plasma motilin in the SPD and PPPD groups started to decreace significantly during the first postoperative week. They came back to the the preoper-ative plasma motilin in the 12~th day postoperation. The plasma motilin in theRoux- en- y group started to increase significantly during the the first postoperative week. They came back to the the preoperative plasma motilin in the12~th day postoperation . The jejunumic mucosa motilin were much more than that of pylor-ic mucosa.3. The serous gatrin in SPD is decreased clearly 7 th days postoperation, the serous gastrin in PPPD and Roux-en-y is the opposition. They began to back to the preoperative plasma gastrin in the 12~th postoperation . The pyloric mucosa gastrin were much more than jejunumic mucosa.4. The PH data of gastric juice show: PH data in SPD is increased significantly during postoperation. PH data in PPPD and Roux-en-y is decreased in the 3 "'day postopertion and began to back to the preoperative levels in the 7 day postoperation.5. The secretion of motilin had positive correlation with gastrointestinal function in postoperation. The secretion of gastrin had not evident correlation with the PH data of gastric juice in preperation, while a negtive one in postoperation. Through the totalling output of nasogastric decompression during 3 days in postopertion, PSRT and AET, we found that the recovery of gastrointestinal after PPPD and Roux-en-y groups is earlier than SPD group, that of PPPD and Roux-en-y is no difference.DiscussionMotilin is a polypeptide hormone localized to Mo cells of the gastroantrum duodenum and proximals intestin. Gastrin is a polypeptide hormone localized to G cells of the gaster. Many clinical studys of digestive tumour have shownn: motilin have more connection with occurrence and grow of the digestive tumour and accelerate the digestive cancer. Takahat' s study showed that there is no different plasma motilin among the rebuilding mode in PPPD. Caplin and Negre have found the receptor of motilin and pre-motilin in pancreatic carcinoma by immu-nohistochemistry. Zhangfenchen proved: gastrin ehanced the threshold cost of apoptosis and restrained the apoptosis of bile duct cancer. Today ,we are short of the dynamic variation motilin and gastrin clinical study enclosing the operation ofpancreatic carcinoma and periampullary adenocarcinoma. Our investigation showed the plasma motilin and serous gastrin in investigative group were much more than that in the control group. This agree with the many clinical studies of digestive tumour. Motilin and gastrin can not only adjust the gastromucosity and maitain the integrity of gatroinnerwall but potentially make the periampullary mu-cosity and pancreatic gland to develop into pancreatic carcinoma and periampullary adenocarcinoma,especially gastrin have the autocrine that has the self feedback that make the tumour cells adjust their ambience and aggravate the vicious circle of the digestive tumour self-expand and self development. The divercifica-tion and anticipated effection of the motilin and gastrin not only agreed with the resume of gastrointestinal function but proved that PPPD, which provide a approximately natural setting of hormone which accelerate the resume of gastrointestinal function while excise the tumour and achieve a radical cure, is better than SPD. Clinical obersation showed : There is an evident positve correlation between postoperative motilin and gastrointestinal function. Because the movement of enclosing operational period motilin looked as if anti-parabola in SPD and PPPD, we should apply the gastric prokinetic drug early till 12thday postoperation, on the contrary that is in Roux-en-y. There is not evident positve correlation between postoperative gastrin and the PH data of gastric juice in preoperation while a negative ony in postoperation. Because the movement of enclosing operational period gastrin looked as if periodicity in PPPD and Roux-en-y,we should apply the anti-gastroacid drug early till 7th day postoperation. Because the gastrin in SPD is very low,we should not apply the anti-gastroacid drug.Conclusions1. The reason of the more concentive plasma motilin and serous gastrin of properative patients is related to the development of pancreatic carcinoma and periampullary adenocarcinoma. The reason of latter is also related to the self feedback of pancreatic carcinoma and periampullary adenocarcinoma.2. The movement of enclosing operation motilin looked as if anti-parabola in SPD and PPPD. on the contrary that is in Roux-en-y. The movement of enclo-...