Results of Pancreatic Blood Shunting into the Systemic Blood Flow in Insulin-Dependent Diabetics

摘要

A new surgical method of treating patients with unstable insulin-dependent diabetes (IDD) has beendeveloped-that of surgically shunting pancreatic blood into the systemic blood flow with the purpose ofcreating a more optimal interaction of subcutaneously administered insulin and pancreas-secretedglucagon.The long term results of the operation depend on the patency of a splenorenal anastomosis. This hasbeen studied by following up 137 patients over periods from half a year to three years. Anastomoticpatency was determined by renal and splenic venography and celiacy arteriography, which revealed apatent anastomosis in 114 patients, and an obliterated one in 23.Patients with patent anastomoses showed a lowering of glycosylated hemoglobin (HbAlc) from13.3±0.03% to 9.3±0.6%, p<0.05, a decrease of the injected insulin dose from 0.97±0.04 to 0.72±0.03 U/ kg, p<0.05, disappearance or considerable abatement of pain in the lower extremities, and of hypoglycemia. Improvement of clinical status was accompanied by an increase of glucagon in the systemic blood stream from 60.8±10.1 to 91.5±9.4 pg/ml, p<0.05, a rise of tissue oxygen pressure, PO2, from 49.2±2.4 to 58.1±1.9 mm Hg, p<0.05. In patients with oblivious anastomoses postoperative HbAlclevels did not change from preoperative values: 12.9±0.4% and 12.8±0.7%, p<0.05, respectively; the insulin dose remained the same-0.91 ±0.07 U/kg and 0.85±0.07 U/kg, p<0.05, no rise of the systemic blood glucagon content was noted, and former complaints continued.The suggested method is not an alternative for insulin therapy, but considerably enhances its potential.