Медицинская литература. Новинки

 

 

 

 

 

 

Эндокринологические аспекты ведения пациентов после дуоденопанкреатэктомии

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В обзоре литературы отражены эндокринологические аспекты ведения пациентов, перенесших тотальную дуоденопанкреатэктомию без трансплантации ?-клеток, в ближайшем и отдаленном послеоперационном периоде. Особенности углеводного обмена после тотальной дуоденопанкреатэктомии требуют иных подходов и способов коррекции. Летальность в специализированных центрах в последнее десятилетие составляет 3-5%. Наибольшее число опасных для жизни осложнений приходится на ранний послеоперационный период и остается большим (?49%), несмотря на соблюдение международных стандартов лечения начиная с отделения реанимации. В раннем послеоперационном периоде особое значение приобретает имитация секреции инсулина здоровой поджелудочной железы. Применение приборов типа “закрытой петли” после тотальной панкреатэктомии позволило выявить необходимую дозу инсулина короткого действия (100-200 Ед/сут внутри венно) для поддержания глюкозы плазмы в диапазоне 4,4-7,7 ммоль/л, обеспечило безопасность пациентов, уменьшило число хирургических осложнений. Индивидуально подобранная инсулинотерапия, заместительная ферментная терапия и сбалансированное питание в отдаленном послеоперационном периоде обеспечивают пациентам, перенесшим дуоденопанкреатэктомию, приемлемое качество жизни, сопоставимое с качеством жизни больных СД 1 и 2 типа.

Ключевые слова:
поджелудочная железа, панкреатэктомия, сахарный диабет, гликемия, инсулинотерапия, pancreas, pancreatectomy, diabetes mellitus, glycemia, insulin therapy

Литература:
1.Kausch W. Das carcinoma der Papilladuodeni und seine radical Entfernung. Betir. Klin. Chir. 1912; 78: 439-486.
2.Rockey E.W. Total pancreatectomy for carcinoma: case report. Ann. Surg. 1943; 118: 603-611.
3.Priestley J.T., Comfort M., Sprague R. Total pancreatectomy for hyperinsulinism due to islet-cells adenoma follow-up report five and one-half years after operation including metabolic studies. Ann. Surg. 1949; 300: 211-217.
4.Кузин М.И., Благовидов Д.Ф., Саркисов Д.С., Помелов В.С., Вишневский В.А., Цвиркун В.В., Савина Т.В. Тотальная дуоденопанкреатэктомия. Хирургия. Журнал им. Н.И. Пирогова. 1982; 6: 17-21.
5.Вишневский В.А., Цвиркун В.В., Буриев И.М., Лебедева А.Н., Саввина Т.В., Марина Г.В., Тарасюк Т.И. Больная через 20 лет после тотальной дуоденопанкреатэктомии. Протокол заседания Хирургического общества Москвы и Московской обл. от 16.09.99. Хирургия. Журнал им. Н.И. Пирогова. 2000; 6: 70-71.
6.Murphy M.M., KnausII W.J., Ng S.C., Hill J.S., McPhee J.T., Shah S.A., Tseng J.F. Total pancreatectomy: a national stady. HPB (Oxford). 2009; 11 (6): 476-482. https://doi.org/10.1111/j.1477-2574.2009.00076.x
7.Crippa S., Tamburrino D., Pattelli S., Salvia R., Germenia S., Bassi C., Pederzoli P., Falconi M. Total pancreatectomy: indications, different timing, and perioperative and long-term outcomes. Surgery. 2011; 149 (1): 79-86. https://doi.org/10.1016/j.surg.2010.04.007
8.Datta J., Levis R.S., Strasberg S.M., Hall B.L., Allendorf J.D., Beane J.D., Behrman S.W., Callery M.P., Christein J.D., Drebin J.A., Epelboym I., He J., Pitt H.A., Winslow E., Wolfgang C., Lee M.K. 4th, Vollmer C.M. Jr. Quantyfying the burden of complications following total pancreatectomy using the postoperative morbidity index: a multi-institutional perspective. Gastrointest. Surg. 2015; 19 (3): 506-515. https://doi.org/10.1007/s11605-014-2706-y
9.Jonston W.C., Hoen H.M., Cassera M.A., Nevell P.H., Hammill C.W., Hansen P.D. Total pancreatectomy for pancreatic ductal adenocarcinoma: review of the national cancer data base. HPB (Oxword). 2016; 18 (1): 21-28. https://doi.org/10.1016/j.hpb.2015.07.009
10.Warren K.W., Cattell R.B. Basic techniques in pancreatic surgery. Surg. Clin. North Am. 1956; 36 (3): 707-724.
11.Janot M.S., Belyaev O., Kersting S., Chromik A.M., Seelig M.H., Sulberg D., Mittelkotter U., Uhl W.H. Indications and early outcomes for total pancreatectomy at a high-volume pancreas center. HPB Surgery. 2010; 2010: 686702. https://doi.org/10.1155/2010/686702
12.Crippa S., Tamburrino D., Pattelli S., Salvia R., Germenia S., Bassi C., Pederzoli P., Falconi M. Total pancreatectomy: indications, different timing, and perioperative and long-term outcomes. Surgery. 2011; 149 (1): 79-86. https://doi.org/10.1016/j.surg.2010.04.007
13.Muller M., Friess H., Kleeff J., Dahmen R., Wagner M., Hinz U., Breisch-Girbig D., Ceyhan G.O., Buchler M.W. Is the still a role for total pancreatectomy? Ann. Surg. 2007; 246 (6): 966-974. https://doi.org/10.1097/SLA.0b013e31815c2ca3
14.Nathan H., Wolfgang C.L., Edil B.H., Choti M.A., Herman J.M., Schulick R.D., Cameron J.L., Pawlik T.M. Peri-operative mortalitity and long-term survival after total pancreatectomy for pancreatic adenocarcinoma population based perspective. J. Surg. Oncol. 2009; 99 (2): 87-92. https://doi.org/10.1002/jso.21189
15.McPhee J.T., Hill J., Whalen G.F., Zayaruzny M., Litwin D.E., Sullivan M.E., Anderson F.A., Tseng J.F. Perioperative mortality for pancreatectomy: a national perspective. Ann. Surg. 2007; 246 (2): 246-253. https://doi.org/10.1097/01.sla.0000259993.17350.3a
16.Reddy S., Wolfgang C.L., Cameron J.L., Eckhauser F., Choti M.A., Schulick R.D., Edil B.H., Pawlik T.M. Total pancreatectomy for pancreatic adenocarcinoma: evalution of morbidity and long-term survival. Ann. Surg. 2009; 250 (2): 282-287. https://doi.org/10.1097/SLA.0b013e3181ae9f93
17.Suzuki S., Kajiama H., Takemura A., Shimazaki J., Nishida K., Shimoda M. The clinical outcomes after total pancreatectomy. Dig. Surg. 2017; 34 (2): 142-150. https://doi.org/10.1159/000449234
18.Шалимов С.А., Осинский Д.С., Черный В.А., Клифф Й., Фрисс Г. Рак поджелудочной железы. Современное состояние проблемы. Киев: Основа, 2007. 315 с.
19.Ross D.E. Cancer of the pancreas. A plea for total pancreatectomy. Am. J. Surg. 1954; 87 (1): 20-33.
20.Егоров В.И., Вишневский В.А., Коваленко З.А., Лебедева А.Н., Мелехина О.В. Тотальная панкреатэктомия. Хирургия. Журнал им. Н.И. Пирогова. 2012; 7: 85-92.
21.Патютко Ю.И., Котельников А.Г. Хирургия органов билиопанкреатодуоденальной зоны. М.: Медицина, 2007. 446 с.
22.Johnston P.C., Lin Y.K., Walsh R.M., Bottino R., Stevens T.K., Trucco M., Bena J., Faiman C., Hatipoglu B.A. Factors accociated with islet yield and insulin independence after total pancreatectomy and islet cell autotransplantation in patient with chronic pancreatitis utilizing offsite islet isolation: Cleveland Clinic experience. J. Clin. Endocrinol. Metab. 2015; 100 (5): 1765-1770. https://doi.org/10.1210/jc.2014-4298
23.Johnston P.C., Hoen H.M., Cassera M.A., Newell P.H., Hammill C.W., Hansen P.D., Wolf R.F. Total pancreatectomy for pancreatic ductal adenocarcinoma: review of the National Cancer Data Base. HPB (Oxford). 2016; 18 (1): 21-28. https://doi.org/10.1016/j.hpb.2015.07.009
24.Кубышкин В.А., Кригер А.Г., Вишневский А.В., Горин Д.С., Лебедева А.Н., Загагов С.О., Ахтанин Е.А. Экстирпация культи поджелудочной железы при профузном внутрибрюшном аррозивном кровотечении, обусловленном послеоперационным панкреатитом. Хирургия. Журнал им. Н.И. Пирогова. 2012; 11: 4-7.
25.Подлужный Д.В., Соловьева О.Н., Котельников А.Г., Делекторская В.В., Козлов Н.А., Сяодун Д., Патютко Ю.И. Высокозлокачественные нейроэндокринные опухоли поджелудочной железы: возможности хирургического метода. Анналы хирургии. 2018; 23 (2): 92-98.
26.Седаков И.Е., Семикоз Н.Г., Жильцов А.В., Антипов В.Н., Бондарь А.В., Коломиец К.С. Завершающая панкреатэктомия при несостоятельности панкреатоеюноанастамоза. Новообразование. 2017; 9 (4): 217-223.
27.Dammann H.G., Besterman H.S., Bloom S.R., Schreiber H.W. Gut-hormone profile in totally pancreatectomized patients. Gut. 1981; 22 (2): 103-107.
28.Miyata M., Tiakao T., Uozumi T., Okamoto E., Manabe H. Insulin secretion after pancreatduodenectomy. Ann. Surg. 1974; 179 (4): 494-497.
29.Stauffer J.A., Nguyen J.H., Heckman M.G., Grewal M.S., Dougherty M., Gill K.R., Jamil L.H., Scimeca D., Raimondo M., Smith C.D., Martin J.K., Asbun H.J. Patient outcomes after total pancreatectomy: a single centre contemporary experience. HPB (Oxford). 2009; 11 (6): 483-492. https://doi.org/10.1111/j.1477-2574.2009.00077.x
30.Satoi S., Murakami Y., Motoi F., Sho M., Matsumoto I., Uemura K., Kawai M., Kurata M., Yanagimoto H., Yamamoto T., Mizuma M., Unno M., Kinoshita S., Akahori T., Shinzeki M., Fukumoto T., Hashimoto Y., Hirono S., Yamaue H., Honda G., Kwon M. Reappraisal of total pancreatectomy in 45 patients with pancreatic ductal adenocarcinoma in the modern era using matched-pairs analysis: multicentrstudy group of pancreatobiliary surgery in Japan. Pancreas. 2016; 45 (7): 1003-1009. https://doi.org/10.1097/MPA.0000000000000579
31.Hartwig W., Gluth A., Hinz U., Bergmann F., Spronk P.E., Hackert T., Werner J., Buchler M.W. Total pancreatectomy for primary pancreatic neoplasms: renaissance of an unpopular operation. Ann. Surg. 2015; 261 (3): 537-546. https://doi.org/10.1097/SLA.0000000000000791
32.Nikfarjam M., Low N., Weinberg L., Chia P.H., He H., Christophi C. Total pancreatectomy for the treatment of pancreatic neoplasms. ANZ J. Surg. 2014; 84 (11): 823-826. https://doi.org/10.1111/ans.12640
33.Gueroult S., Parc Y., Duron F., Paye F., Parc R. Completion pancreatectomy for postoperative peritonitis after pancreaticoduodenectomy: early and late outcome. Arch. Surg. 2004; 139 (1): 16-19. https://doi.org/10.1001/archsurg.139.1.16
34.Cunningham J.D., O`Donnell N., Starker P. Surgical outcomes following pancreatic resection at a low-volume communitiv hospital: do all patients need to be sent a regional cancer center? Am. J. Surg. 2009; 198 (2): 227-230. https://doi.org/10.1016/j.amjsurg.2008.10.023
35.Helm J.F., Centeno B.A., Coppola D., Druta M., Park J.Y., Chen D.T., Hodul P.J., Kvols L.K., Yeatman T.J., Carey L.C., Karl R.C., Malafa M.P. Outcomes following resections of pancreatic adenocarcinoma: 20-year experience at a single institution. Cancer Control. 2008; 15 (4): 288-294. https://doi.org/10.1177/107327480801500403
36.Doi K., Prentki M., Yip C., Muller W.A., Jeanrenaud B., Vranic M. Identical biological effects of pancreatic glucagon and purified moiety of canine gastric immunoreactive glucagons. J. Clin. Invest. 1979; 63 (3): 525-531. https://doi.org/10.1172/JCI109331
37.Muller W.A., Brennan M.F., Tan M.H., Aoki T.T. Studies of glucagon secretion in pancreatectomized patients. Diabetes. 1974; 23 (6): 512-516.
38.Slezak L.A., Anderson D.K. Pancreatic resection: effect of glucose metabolism. World J. Surg. 2001; 25 (4): 452-460. https://doi.org/10.1007/s002680020337
39.Fisher W.E., Andersen D.K., Bell R.H. Pancreas. In: Brunicardi F.C. (ed.) Schwartz’s principles of surgery. 8th ed. New York: McGraw-Hill, 2005: 1252-1254.
40.Anderson D. Mechanisms and emerging treatments of the metabolic complications of chronic pancreatitis. Pancreas. 2007; 35 (1): 1-15. https://doi.org/10.1097/mpa.0b013e31805d01b0
41.Kono T., Hanazaki K., Yazawa K., Ashizawa S., Fisher W.E., Wang X.P., Nose Y., Brunicardi F.C. Pancreatic polypeptide administration reduces insulin requirements of articial pancreas in pancreatectomized dogs. Artif. Organs. 2005; 29 (1): 83-87. https://doi.org/10.1111/j.1525-1594.2004.29008.x
42.Boyle P.J. Alteration in brain glucose metabolism induced by hypoglycemia in man. Diabetologia. 1997; 40 (Suppl. 2): S69-S74.
43.American Diabetes Association. Diabetes care in the hospital: Standards of Medical Care in Diabetes 2019. Diabetes Care. 2019; 42 (Suppl. 1): S173-S181.
44.Vigili de Keutzenberg S., Maifreni L., Lisato G., Riccio A., Trevisan R., Tiengo A., Del Prato S. Glucose turnover and recycling in diabetes secondary to total pancreatectomy: effect of glucagon infusion. J. Clin. Endocrinol. Metab. 1990; 70 (4): 1023-1029. https://doi.org/10.1210/jcem-70-4-1023
45.Jamil L.H., Chindris A.M., Gill K.R., Scimeca D., Stauffer J.A., Heckman M.G., Meek S.E., Nguyen J.H., Asbun H.J., Raimondo M., Woodward T.A., Wallace M.B. Glycemic control after total pancreatectomy for intraductal papillary mucinous neoplasm: an exploratory stady. HPB Surg. 2012; 2012: 381-328. https://doi.org/10.1155/2012/381328
46.Dressler C.M., Fortner J.G., McDermott K., Bajorunas D.R. Metolic consequences of (regional) total pancreatectomy. Ann. Surg. 1991; 214 (2): 131-140.
47.Tankjoh K., Tomita R., Mera K., Hayashi N. Metabolic modulation by concomitant administration of insulin and glucagon in pancreatectomy patients. Hepato gastro enterology. 2002; 49 (44): 538-543.
48.Barbier L., Jamal W., Dokmak S., Aussilhou B., Corcos O., Ruszniewski P., Belghiti J., Sauvanet A. Impact of total pancreatectomy: short- and long-term assessment. HPB Oxford. 2013; 15 (11): 882-892. https://doi.org/10.1111/hpb.12054
49.Дедов И.И., Шестакова М.В. (ред.) Алгоритмы специализированной медицинской помощи больным сахарным диабетом. Клинические рекомендации: 7-й вып. Сахарный диабет. 2015; 18 (Прил. 1): 1-112.
50.Takami H., Fujii T., Kanda M., Suenaga M., Yamamura K., Kodera Y. Preservation of the pyloric ring confers little benefit in patients undergoing total pancreatectomy. Word J. Surg. 2014; 38 (7): 1807-1813. https://doi.org/10.1007/s00268-014-2469-3
51.Landoni L., Salvia R., Festa L., Muselli P., Giardino A., Butturini G., Falconi M., Bassi C. Quality of life after total pancreatectomy. Ten-year experience. JOP. J. Pancreas (Online). 2004; 5 (Suppl. 5): 441.
52.Kahl S., Malfertheiner P. Exocrine and endocrine pancreatic insufficiency after pancreatic surgery. Best Pract. Res. Clin. Gastroenterol. 2004; 18 (5): 947-955. https://doi.org/10.1016/j.bpg.2004.06.028
53.Van den Berghe G., Wouters P., Weekers F., Verwaest C., Bruyninckx F., Schetz M., Vlasselaers D., Ferdinande P., Lauwers P., Bouillon R. Intensive insulin therapy in critically ill patients. N. Engl. J. Med. 2001; 345 (19): 1359-1367. https://doi.org/10.1056/NEJMoa011300
54.Griesdale D.E., de Souza R.J., van Dam R.M., Heyland D.K., Cook D.J., Malhotra A., Dhaliwal R., Henderson W.R., Chittock D.R., Finfer S., Talmor D. Intensive insulin therapy and mortality amoung critically ill patients: meta-analysis including NICE-SUGAR study data. CMAJ. 2009; 180 (8): 821-827. https://doi.org/10.1503/cmaj.090206
55.Wiener R.S., Wiener D.C., Larson R.J. Benefits and risk of tight glucose control in critically ill adults: a meta-analysis. JAMA. 2009; 300 (8): 933-944. https://doi.org/10.1001/jama.300.8.933
56.Magee M.F., Clement S. Subcutaneous insulin therapy in the hospital setting: issues, concerns, and implementation. Endocr. Pract. 2004; 10 (Suppl. 2): 81-88. https://doi.org/10.4158/EP.10.S2.81
57.Moghissi E.S., Korylkowsky M.T., DiNordo M.M., Einhorn D., Hellman R., Hirsch I.B., Inzucchi S.E., Ismail-Beigi F., Kirkman M.S., Umpierrez G.E. American Association of Clinical Endocrinologists and American Association consensus statement on glycemic control. Diabetes Care. 2009; 32 (6): 1119-1131. https://doi.org/10.2337/dc09-9029
58.Inzucchi S.E., Siegel M.D. Glucose control in the ICU - how tight is too tight? N. Engl. J. Med. 2009; 360 (13): 1346-1349. https://doi.org/10.1056/NEJMe0901507
59.Scott M.G., Bruns D.E., Boyd J.C., Sacks D.B. Tight glucose control in the intensive care unit: are glucose meters up to the task? Clin. Chem. 2009; 55 (1): 18-20. https://doi.org/10.1373/clinchem.2008.117291
60.Kynoch K. Implementation of a glucose management protocol to prevent hypo- and hyperglycemia in critically ill patients. Int. J. Evid. Based Healthc. 2008; 6 (4): 468-475. https://doi.org/10.1111/j.1744-1609.2008.00116.x
61.Takesue Y., Tsuchida T. Strict glycemic control to prevent surgical site infection in gastroenterogical surgery. Ann. Gastroenterol. Surg. 2017; 1 (1): 52-59. https://doi.org/10.1002/ags3.12006
62.Alexanian S., McDonell M.E., Akhtar S. Creating a perioperative glycemic control program. Anesthesiol. Res. Pract. 2011; 2011: 465974. https://doi.org/10.1155/2011/465974
63.Wilson M., Weinreb J., Hoo G.W. Intensive insulin therapy in critical care: a review of 12 protocols. Diabetes Care. 2007; 30 (4): 1005-1011. https://doi.org/10.2337/dc06-1964
64.Okabayashi T., Hnazaki K., Nichimori I., Sugimoto T., Maeda H., Yatabe T., Dabanaka K., Kobayashi M., Yamashita K. Continuous postoperative blood-glucose monitoring and control using a closed loop system in patients undergoing hepatic resection. Dig. Dis. Sci. 2008; 53 (5): 1405-1410. https://doi.org/10.1007/s10620-007-0010-3
65.Лебедева А.Н. Состояние углеводного обмена у больных после резекций поджелудочной железы: автореф. дис. … канд. мед. наук. М., 1992. 22 с.
66.Maeda H., Okabayashi T., Yatabe T., Yamashita K., Hanazaki K. Perioperative intensive insulin therapy using artificial endocrine pancreas undergoing pancreatectomy. World J. Gastroenterol. 2009; 15 (33): 4111-4115. https://doi.org/10.3748/wjg.15.4111
67.Svensson A.M., McGuire D.K., Abrahamsson P., Dellborg M. Association between hyper- and hypoglycemia and 2-year allcause mortality risk in diabetic patients with acute coronary events. Eur. Heart J. 2005; 26 (13): 1255-1261. https://doi.org/10.1093/eurheartj/ehi230
68.Goldberg P.A., Siegel M.D., Sherwin R.S., Halickman J.I., Lee M., Bailey V.A., Dziura J.D., Inzucchi S.E. Implementation of safe and effective insulin infusion protocol in a medical intensive care unit. Diabetes Care. 2004; 27 (2): 461-467. https://doi.org/10.2337/diacare.27.2.461
69.Engerman R.L., Kern T.S. Progression of incipient diabetic retinopathy during good glycemic control. Diabetes. 1987; 36 (7): 808-812. https://doi.org/10.2337/diab.36.7.808
70.The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N. Engl. J. Med. 1993; 329 (14): 977-986. https://doi.org/10.1056/NEJM199309303291401
71.Gabbay K.H., Merola L.O., Field R.A. Sorbitol pathway: presence in nerve and cord with substrate accumulation in diabetes. Science. 1966; 151 (3707): 209-210. https://doi.org/10.1126/science.151.3707.209
72.Brownlee M. The pathobiology of diabetic complications: a unifying mechanism. Diabetes. 2005; 54 (6): 1615-1625. https://doi.org/10.2337/diabetes.54.6.1615
73.Ceriello A., Ihnat M.A., Thorpe J.E. Clinical review 2: The “metabolic memory”: is more than just tight glucose control necessary to prevent diabetic complications? J. Clin. Endocrinol. Metab. 2009; 94 (2): 410-415. https://doi.org/10.1210/jc.2008-1824
74.Julius U., Drel V.R., Grassler J., Obrosova I.G. Nitrosylated proteins in monocytes as a new marker of oxidative-nitrosative stress in diabetic subjects with macroangiopathy. Exp. Clin. Endocrinol. Diabetes. 2009; 117 (2): 72-77. https://doi.org/10.1055/s-2008-1078710
75.Huebschmann A.G., Regensteiner J.G., Vlassara H., Reusch J.E. Diabetes and advanced glycoxidation end products. Diabetes Care. 2006; 29 (6): 1420-1432. https://doi.org/10.2337/dc05-2096
76.Yan S.F., Ramasamy R., Naka Y., Schmidt A.M. Glycation, inflammation, and RAGE: a scaff old for the macrovascular com plications of diabetes and beyond. Circ. Res. 2003; 93 (12): 1159-1169. https://doi.org/10.1161/01.RES.0000103862. 26506.3D
77.Basta G., Lazzerini G., Del Turco S., Ratto G.M., Schmidt A.M., De Caterina R. At least 2 distinct pathways generating reactive oxygen species mediate vascular cell adhesion molecule-1 induction by advanced glycation end products. Arterioscler. Thromb. Vasc. Biol. 2005; 25 (7): 1401-1407. https://doi.org/10.1161/01.ATV.0000167522.48370.5e
78.Данилов М.В., Благовидов Д.Ф., Помелов В.С., Ганжа П.Ф. Панкреатодуоденальная резекция или тотальная панкреатэктомия? Вестник хирургии им. И.И. Грекова. 1981; 2: 139-146.
79.Данилов М.В., Помелов В.С., Вишневский В.А., Буриев И.М., Вихорев А.В., Казанчян П.О., Савина Т.В. Методика панкреатодуоденальной резекции и тотальной дуоденопанкреатэктомии. Хирургия. Журнал им. Н.И. Пирогова. 1990; 10: 94-100.
80.Данилов М.В., Буриев И.М., Вихорев А.В. Тотальная дуоденопанкреатэктомия в условиях коррекции углеводного обмена аппаратом ”Биостатор“. Хирургия. Журнал им. Н.И. Пирогова. 1993; 9: 91-93.
81.Wallia A., Umpierrez G.E., Rushakoff R.J., Klonoff D.C., Rubin D.J., Hill Golden S., Cook C.B., Thompson B; DTS Continuous Glucose Monitoring in the Hospital Panel. Consensus statement on inpatient use of continuous glucose monitoring. J. Diabetes Sci. Technol. 2017; 11 (5): 1036-1044. https://doi.org/10.1177/1932296817706151
82.Umpierrez G.E., Klonoff D.C. Diabetes technology update: use of insulin pumps and continuous glucose monitoring in the hospital. Diabetes Care. 2018; 41 (8): 1549-1589. https://doi.org/10.2337/dci18-0002
83.Gomez A.M., Umpierrez G.E. Continuous glucose monitoring in insulin-treated patients in non-ICU setting. J. Diabetes Sci. Technol. 2014; 8 (5): 830-936. https://doi.org/10.1177/1932296814546025
84.Krinsley J.S., Chase J.G., Gunst J., Martensson J., Schultz M.J., Taccone F.S., Wernerman J., Bohe J., De Block C., Desaive T., Kalfon P., Preiser J.C. Continuous glucose monitoring in the ICU: clinical considerations and consensus. Crit. Care. 2017; 21 (1): 197. https://doi.org/10.1186/s13054-017-1784-0
85.Chase J.G., Desaive T., Bohe J., Cnop M., De Block C., Gunst J., Hovorka R., Kalfon P., Krinsley J., Renard E., Preiser J.C. Improving glycemic control in critically ill patients: personalized care to mimic the endocrine pancreas. Crit. Care. 2018; 22 (1): 182. https://doi.org/10.1186/s13054-018-2110-1
86.Hanazaki K., Nose Y., Brunicardi F.C. Artifical endocrine pancreas. J. Am. Coll. Surg. 2001; 193 (3): 310-322.
87.Tsukamoto Y., Okabayashi T., Hanazaki K. Progressive artificial endocrine pancreas: era of novel perioperative blood glucose control for surgery. Surg. Today. 2011; 41 (10): 1344-1351. https://doi.org/10.1007/s00595-011-4537-8
88.Parsaik A.K., Murad M.H., Sathananthan A., Moorthy V., Erwin P.J., Chari S., Carter R.E., Farnell M.B., Vege S.S., Sarr M.G., Kudva Y.C. Metabolic and target organ outcomes after total pancreatectomy: Mayo Clinic experience and meta-analysis of the literature. Clin. Endocrinol. (Oxf.). 2010; 73 (6): 723-731. https://doi.org/10.1111/j.1365-2265.2010.03860.x
89.Epelboym I., Winner M., DiNorica J., Lee M.K., Lee J.A., Schrope B., Chabot J.A., Allendore J.D. Quality Life in Patients after total pancreatectomy in comparable with quality life of the life in patients who undergo a partial pancreatic resection. J. Surg. Res. 2014; 187 (1): 189-196. https://doi.org/10.1016/j.jss.2013.10.004
90.Егоров В.И. Можно ли родить без поджелудочной железы и можно ли родить после рака? 2018. URL:http://doctoregorov.ru/?p=2397

Endocrinological aspects of managing patients after total duodenopancreat ectomy

The presented review of literature reflects the endocrinological aspects of patient management after total duodenopancreatectomy without ?-cell transplantation in the immediate and late postoperative period. Peculiarities of carbohydrate metabolism after total duodenopancreatectomy require other approaches and methods of correction. Mortality in specialized centers in the last decade is 3-5%. The largest number of life-threatening complications occurs in the early postoperative period and remains high (49% and higher) despite the observance of international treatment standards, starting from the intensive care unit. In the early postoperative period, imitation of insulin secretion from a healthy pancreas is of particular importance. The use of devices of the “closed loop” type after total pancreatectomy made it possible to identify the required dose of short-acting insulin (100-200 units per day intravenously) to maintain plasma glucose in the range 4.4-7.7 mmol/l, ensured patient safety, and reduced the number of surgical complications. Individually selected insulin therapy, enzyme replacement therapy and balanced nutrition in the long-term postoperative period provide patients who have undergone total duodenopancreatectomy an acceptable standard of living comparable to the quality of life of patients with type 1 and type 2 diabetes.

Keywords:
поджелудочная железа, панкреатэктомия, сахарный диабет, гликемия, инсулинотерапия, pancreas, pancreatectomy, diabetes mellitus, glycemia, insulin therapy