WordNet

determine the sum of; "Add all the people in this town to those of the neighboring town" (同)tot, tot up, sum, sum_up, summate, tote up, add, add together, tally, add up
damage beyond the point of repair; "My son totaled our new car"; "the rock star totals his guitar at every concert"
add up in number or quantity; "The bills amounted to $2,000"; "The bill came to $2,000" (同)number, add up, come, amount
a small amount (especially of a drink); "a tot of rum"
surgical removal of part or all of the pancreas
used of automobiles; completely demolished; "the insurance adjuster declared the automobile totaled"

PrepTutorEJDIC

『総計の』,全体の / 『全くの』,完全な(absolute) / 『合計』,総額,総数,総量(sum) / …‘を'合計する / 合計…‘に'なる,総額が…‘に'のぼる(amount to)
幼児,小児 / (特に酒類の)少量,一杯,一口
…‘を'合計する《+up+名,+名+up》 / 合計(…に)なる《+up to+名》

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/07/13 22:04:46」(JST)

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In medicine, a pancreatectomy is the surgical removal of all or part of the pancreas. Several types of pancreatectomy exist, including pancreaticoduodenectomy (Whipple procedure), distal pancreatectomy, segmental pancreatectomy, and total pancreatectomy. These procedures are used in the management of several conditions involving the pancreas, such as benign pancreatic tumors, pancreatic cancer, and pancreatitis.

Indications

It is performed for a variety of reasons, including:

Inflammation
- Necrotising pancreatitis
- Chronic pancreatitis with pain
Trauma
Neoplasms
- Adenocarcinoma (85%)
- Cystadenoma (mucinous/serous)
- Cystadenocarcinoma
- Islet cell tumors (neuroendocrine tumors)
- Papillary cystic neoplasms
- Lymphoma
- Acinar cell tumors
Severe hyperinsulinemic hypoglycemia

Types

The most common surgical procedure involving removal of a portion of the pancreas is called a pancreaticoduodenectomy.

Among common consequences of complete or nearly complete pancreatectomy are deficiencies of pancreatic endocrine or exocrine function requiring replacement of insulin or digestive enzymes. The patient immediately develops type I diabetes, with little hope for future type I diabetes treatments involving the restoration of endocrine function to a damaged pancreas, since the pancreas is either partially or completely absent. Type I diabetes can be treated with careful blood glucose monitoring and insulin therapy. Because the Pancreas is responsible for the production of many digestive enzymes, a pancreatectomy should only be given as an option for pancreatic disease which is life-threatening, such as pancreatic cancers. It is very important to note that even after a pancreatectomy, pain still exists in most patients.

A distal pancreatectomy is removal of the body and tail of the pancreas.

Prognosis

Prognosis for patients living without a pancreas is very poor. Without the endocrine hormones (glucagon, insulin, somatostatin, and pancreatic polypeptide) or the exocrine enzymes (trypsin, chymotrypsin, pancreatic lipase and amylase) a patient would be on a lengthy regimen of medications and would be severely limited in his or her diet.

An adjunct procedure called islet cell transplantation exists to help mediate the loss of endocrine function following total pancreatectomy.

UpToDate Contents

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1. Total pancreatectomy
2. 膵外分泌癌の治療における外科手術の概要 overview of surgery in the treatment of exocrine pancreatic cancer and prognosis
3. 糖尿病における膵臓および膵島移植 pancreas and islet transplantation in diabetes mellitus
4. Familial risk factors for pancreatic cancer and screening of high-risk patients
5. 慢性膵炎の治療 treatment of chronic pancreatitis

English Journal

Risk of morbidity and mortality following hepato-pancreato-biliary surgery.

Kneuertz PJ, Pitt HA, Bilimoria KY, Smiley JP, Cohen ME, Ko CY, Pawlik TM.SourceDepartment of Surgery, Johns Hopkins Hospital, 600 N. Wolfe Street, Harvey 611, Baltimore, MD, 21287, USA.
Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract.J Gastrointest Surg.2012 Sep;16(9):1727-35. Epub 2012 Jul 4.
INTRODUCTION: Hepatic, pancreatic, and complex biliary (HPB) surgery can be associated with major morbidity and significant mortality. For the past 5 years, the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) has gathered robust data on patients undergoing HPB
PMID 22760965

Total pancreatectomy with islet autotransplantation for chronic pancreatitis: do patients with prior pancreatic surgery have different outcomes?

Morgan KA, Theruvath T, Owczarski S, Adams DB.SourceDepartment of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA.
The American surgeon.Am Surg.2012 Aug;78(8):893-6.
Total pancreatectomy with immediate islet autotransplantation (IAT) can be an effective therapy in patients with chronic pancreatitis. Patient selection criteria for radical resection are not well defined. The impact of prior pancreatic surgery on quality of life outcomes in patients undergoing IAT
PMID 22856498