Department of Surgery, University of Minnesota, Minneapolis, MN 55455, USA.
Pancreas. 2010 Jan;39(1):57-63. doi: 10.1097/MPA.0b013e3181b8ff71.
The probability of insulin independence after intraportal islet autotransplantation (IAT) for chronic pancreatitis (CP) treated by total pancreatectomy (TP) relates to the number of islets isolated from the excised pancreas. Our goal was to correlate the islet yield with the histopathologic findings and the clinical parameters in pediatric (age, <19 years) CP patients undergoing TP-IAT.
Eighteen pediatric CP patients aged 5 to 18 years (median, 15.6 years) who underwent TP-IAT were studied. Demographics and clinical history came from medical records. Histopathologic specimens from the pancreas were evaluated for presence and severity of fibrosis, acinar cell atrophy, inflammation, and nesidioblastosis by a surgical pathologist blinded to clinical information.
Fibrosis and acinar atrophy negatively correlated with islet yield (P = 0.02, r = -0.50), particularly in hereditary CP (P = 0.01). Previous duct drainage surgeries also had a strong negative correlation (P = 0.01). Islet yield was better in younger (preteen) children (P = 0.02, r = -0.61) and in those with pancreatitis of shorter duration (P = 0.04, r = -0.39).
For preserving beta cell mass, it is best to perform TP-IAT early in the course of CP in children, and prior drainage procedures should be avoided to maximize the number of islets available, especially in hereditary disease.
在全胰切除术（TP）治疗慢性胰腺炎（CP）后进行门静脉内胰岛自体移植（IAT）后实现胰岛素独立性的可能性与从切除的胰腺中分离出的胰岛数量有关。我们的目标是将胰岛产量与儿科（年龄 <19 岁）CP 患者接受 TP-IAT 时的组织病理学发现和临床参数相关联。
研究了 18 名年龄在 5 至 18 岁（中位数，15.6 岁）接受 TP-IAT 的儿科 CP 患者。人口统计学和临床病史来自病历。胰腺的组织病理学标本由一名对临床信息不知情的外科病理学家评估纤维化、腺泡细胞萎缩、炎症和胰岛细胞增生的存在和严重程度。
纤维化和腺泡萎缩与胰岛产量呈负相关（P = 0.02，r = -0.50），尤其是在遗传性 CP 中（P = 0.01）。先前的胆管引流手术也有很强的负相关（P = 0.01）。年龄较小（青春期前）的儿童（P = 0.02，r = -0.61）和胰腺炎病程较短的儿童（P = 0.04，r = -0.39）的胰岛产量更好。
为了保留β细胞质量，在 CP 病程早期对儿童进行 TP-IAT 是最佳的，应避免先前的引流手术，以最大限度地增加可用胰岛的数量，特别是在遗传性疾病中。
