Perioperative use of somatostatin in pancreatic surgery.
The prophylactic effect of perioperative use of somatostatin on postoperative increase of pancreatic enzymes was investigated in this double blind, randomized study. Thirty tree patients undergoing pancreatic surgery because of chronic pancreatitis or its complications were divided randomly into two groups. Fifteen patients received somatostatin (dose 125 micrograms/hour), 18 placebo-infusion pre-, and postoperatively for a total time of 48 hours. The level of serum amylase, lipase, gammaGT, calcium, creatinine and blood glucose was determined every 12 hours. In the placebo treated group the serum lipase and amylase increased significantly (p < 0.001), while the calcium decreased. In the somatostatin treated patients only the lipase level increased significantly (p < 0.01), while the amylase and calcium showed no significant changes compared to their initial values. The postoperative increase in serum enzyme levels is interpreted as being an indicator of pancreatic injury. These results suggest that the perioperative use of somatostatin has beneficial effect for the prevention of pancreatic enzymes increases and of pancreatic injuries, associated with pancreatic surgery in patients with chronic pancreatitis. The clinical experiences suggest that the asymptomatic increase in pancreatic amylase following abdominal surgery is the result of various types of injuries of the pancreas (1-3). Included in these injuries is the direct mechanical damage of the parenchyma and ducts but it can develop secondary, as a result of vascular lesion, ischaemia, oedema as well as mechanical injury to the Oddi sphincter of the sphincter's drug induced spasm (1, 2). The asymptomatic increase in serum amylase and lipase can thus be interpreted as being an indicator of surgical pancreatic injury (3).(ABSTRACT TRUNCATED AT 250 WORDS)
Tulassay
Z
Z
Department of Internal Medicine, University Medical School, Budapest, Hungary.
Flautner
L
L
Sándor
Z
Z
Fehérvári
I
I
D000328:Adult; D000681:Amylases / Q000097:blood; D002908:Chronic Disease; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D008049:Lipase / Q000097:blood; D008297:Male; D010179:Pancreas / Q000201:enzymology / Q000601:surgery*; D010195:Pancreatitis / Q000150:complications / Q000601:surgery; D011183:Postoperative Complications / Q000517:prevention & control; D011300:Preoperative Care; D013004:Somatostatin / Q000627:therapeutic use*
D013004:Somatostatin; D008049:Lipase; D000681:Amylases