Ethiopathogenic factors of endocrine dysfunction of pancreas in patients with chronic pancreatitis

Abstract

Introduction. The risk of developing diabetes mellitus in patients with chronic pancreatitis is 25-75 % throughout life and depends on the method of surgical treatment, the etiology of the disease and the degree of damage of the pancreas. The purpose of the study was to determine the features of the functional status of the pancreas in case of chronic pancreatitis, to study its influence on the endocrine function and various methods of surgical interventions on the pancreas, and to determine the terms of surgery. Materials and methods. The study included 105 patients, which were divided into groups: group I (n=14) – resection operations; group II (n=47) –duodenopreserving operation of head of the pancreas with draining of the main pancreatic duct; group III (n=44) – drainage, in which the parenchyma of the pancreas has not been removed. Laboratory blood glucose levels, glycated hemoglobin and C-peptide were measured, glucose tolerance test was performed in the pre- and postoperative period. In the preoperative period, the prevalence of endocrine insufficiency was 27,6 %. In the postoperative period, the prevalence of endocrine insufficiency (non-corrected over the duration of the observation) was 42,9 % (n=45) of patients, among them: 30 – glucose tolerance and 15 – diabetes mellitus. Results.The largest increase in endocrine insufficiency was observed among patients undergoing resection surgery, especially in patients with distal pancreatic resection, while organo-preserving procedures and isolated removal of head of the pancreas had a smaller increase (p = 0,001). Reducing the level of C-peptide in blood plasma in patients with pancreatic parenchymal calcinosis after surgery can predict the development of carbohydrate metabolism disturbances up to and including diabetes mellitus. In the histological study, progressive fibrosis of the parenchyma of the pancreas with inflammatory and degenerative changes has been detected, which leads to a decrease in the ganglia cells and β-cells of the Langegars islets. It was noted that in patients with chronic pancreatite, who had surgery while the duration of the disease was up to 1 year, the incidence of carbohydrate metabolism in the postoperative period was less frequent than in patients with anamnesis over 1 year (p = 0,02). Conclusion.Therefore, we proposed a policy of early surgical intervention – before the development of irreversible functional disorders, which leads to endocrine or exocrine insufficiency.