Young Carlton J
University of Alabama at Birmingham, Birmingham, Alabama, USA.
Curr Opin Organ Transplant. 2009 Feb;14(1):90-4. doi: 10.1097/MOT.0b013e328320a8d9.
Controversy remains regarding the best methodology of handling exocrine pancreatic fluid and pancreatic venous effluent. Bladder drainage has given way to enteric drainage. However, is there an instance in which bladder drainage is preferable? Also, hyperinsulinemia, as a result of systemic venous drainage (SVD), is claimed to be proatherosclerotic, whereas portal venous drainage (PVD) is more physiologic and less atherosclerotic.
Bladder drainage remains a viable method of exocrine pancreas drainage, but evidence is sparse that measuring urinary amylase has a substantial benefit in the early detection of acute rejection in all types of pancreas transplants. Currently, there is no incontrovertible evidence that systemic hyperinsulinemia is proatherosclerotic, whereas recent metabolic studies on SVD and PVD showed that there was no benefit to PVD.
Given the advent of newer immunosuppressive agents and overall lower acute rejection rates, the perceived benefit of bladder drainage as a means to measure urinary amylase as an early marker of rejection has not been substantiated. However, there may be a selective role for bladder drainage in 'high risk' pancreases. Also, without a clear-cut metabolic benefit to PVD over SVD, it remains the surgeon's choice as to which method to use.
关于处理胰腺外分泌液和胰腺静脉流出液的最佳方法仍存在争议。膀胱引流已被肠内引流所取代。然而，是否存在膀胱引流更可取的情况呢？此外，由于体静脉引流（SVD）导致的高胰岛素血症被认为具有促动脉粥样硬化作用，而门静脉引流（PVD）则更符合生理且动脉粥样硬化程度较低。
膀胱引流仍是胰腺外分泌引流的一种可行方法，但几乎没有证据表明测量尿淀粉酶对所有类型胰腺移植急性排斥反应的早期检测有实质性益处。目前，尚无确凿证据表明全身性高胰岛素血症具有促动脉粥样硬化作用，而最近关于SVD和PVD的代谢研究表明，PVD并无优势。
鉴于新型免疫抑制剂的出现以及总体急性排斥反应率的降低，膀胱引流作为测量尿淀粉酶以作为排斥反应早期标志物的益处尚未得到证实。然而，膀胱引流在“高风险”胰腺中可能具有选择性作用。此外，由于PVD相对于SVD在代谢方面并无明显优势，外科医生仍可自行选择使用哪种方法。
