Long-time Following Up Of Pancreatic And Gastrointestinal Function After Inserting Pancreaticogastrostomy

Objective：To compare the longtime outcomes of pancreatic and gastrointestinal function of,Inserting pancreaticogastrostomy(IPG)with the conventionalpancreaticojejunostomy(CPJ)following pancreaticoduodenectomy.Methods: We collected medical records of220patients who underwent PD from March2009to March2013in our institution. According to the following criteria to screen patients:（1）patients diagnosed with benign and I-II Periampullary adenocarcinoma;（2）All the studiedpatients were followed up for more than1year（3）All patients have no signs of tumor recurrenceduring follow-up；（4）We excluded patients with chronic-calcified pancreatitis, patientsaddicted to alcohol, and patients who had previously undergone a gastrointestinalsurgery.Finally，a total of58patients were enrolled in this research，31patients underwent IPGand27patients underwent CPJ，the median follow-up35.7±1.3months. We compared thepancreatic and gastrointestinal function of two procedures through the following ways：1、Laboratory tests：fasting blood glucose, glycohemoglobin A1C (HbA1c), Serum total protein,albumin, cholesterol, triglyceridestool and routine were metured；2、Imaging study：pancreaticduct diameter on computed tomography (CT)；3、Questionnaire：questioning the presence orabsence of steatorrhea，nature of stool，bloated feeling in abdomen，,food aversion et al.Finally,comprehensive laboratory tests, imaging studies and survey results, combined with theinternational diagnostic criteria for diabetes, to determine whether patients with new-onset diabetesand steatorrhea, while the evaluate the digestive function of patients. Patients who there weresteatorrhea and new-onset diabetes or not，were considered endocrine and exocrine pancreaticinsufficiency.Result: IPG （n=31）and CPJ（n=27）of total58patients demonstate no difference inage, gender, pathological diagnosis and follow-up time.a total of16cases(28%) developed varyingdegrees of steatorrhea.Among these IPG is9cases(29%)and CPJ is7cases(25.9%). A total of5patients during follow-up appeared new-onset diabetes, IPG group3patients (9.7%), CPJ group2patients (7.4%)(P>0.05). There was no significant difference between CPJ and IPG groups. Asignificantly decreased postoperative nutritional state regarding total cholesterol andtriglycerides were noticed in both groups.There was no significant difference in terms ofSerum HbA1c，fasting blood glucose level， changes in pancreatic duct diameter and gastric symptom(p＞0.05).Conclusions:Patients who underwent PD had reduction of exocrine and endocrine pancreaticfunction，gastrointestinal function.This might be associated with PD surgery itself, but notwith pancreatic reconstruction.