Dafoe D C, Naji A, Perloff L J, Barker C F
Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia.
Hepatogastroenterology. 1990 Jun;37(3):307-15.
The techniques of segmental pancreatic autotransplantation and intraportal islet autografting have been reported to prevent diabetes after resection of the diseased pancreas. Unless total pancreatectomy is done, transplant function cannot be assessed without measuring insulin in the venous effluent. Islet infusion appears to be a more uncertain technique than segmental autotransplantation, probably because of technical difficulties in obtaining sufficient islets. Both methods have serious potential for morbidity and mortality, which must be balanced against the possible benefits of improved glucose homeostasis. In segmental autografts we recommend an intraperitoneal transplant site with iliac vessel anastomosis, and a lateral pancreaticojejunostomy to provide ductal drainage. For islet transplantation we recommend extreme caution and the use of only very pure islet preparations for portal vein infusions. There is insufficient long-term follow-up of patients with successful auto- or allotransplants to be certain that secondary complications of diabetes will be less than those of patients on insulin therapy. Further experience is necessary before the long-term functional survival of segmental or islet autografts will be known.
节段性胰腺自体移植和门静脉内胰岛自体移植技术已被报道可预防病变胰腺切除术后的糖尿病。除非进行全胰切除术，否则不测量静脉流出物中的胰岛素就无法评估移植功能。胰岛输注似乎是一种比节段性自体移植更不确定的技术，可能是因为获取足够胰岛存在技术困难。两种方法都有严重的发病和死亡风险，必须与改善血糖稳态的潜在益处相权衡。在节段性自体移植中，我们建议将移植部位置于腹腔内，进行髂血管吻合，并采用侧胰空肠吻合术以提供导管引流。对于胰岛移植，我们建议极度谨慎，并且仅使用非常纯净的胰岛制剂进行门静脉输注。自体或同种异体移植成功的患者缺乏足够的长期随访，无法确定糖尿病的继发并发症是否会少于接受胰岛素治疗的患者。在了解节段性或胰岛自体移植的长期功能存活情况之前，还需要进一步的经验。
