Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Leicester, UK.
Pancreatology. 2011;11(2):233-9. doi: 10.1159/000324273. Epub 2011 May 17.
Islet autotransplantation requires access to the portal vein or tributaries. We originally infused islets into the liver via the middle or right colic veins, but since 2005 we have used the recanalised umbilical vein. Here, we describe the technique, the advantages and the early results achieved.
After removal of the pancreas and restoration of the biliary and enteric continuity, the ligamentum teres is transected. The obliterated umbilical vein is identified and recanalised with Bakes dilators giving access to the left portal vein. A Vygon® Nutricath 'S' 11-Fr catheter is inserted and used for the islet infusion. If the ligamentum teres is to be exteriorised for postoperative measurements or subsequent access, it is pulled through a 10-mm laparoscopic port in the epigastrium, sutured to the skin and covered with a dressing.
We have used this approach in 17 patients and exteriorised the falciform ligament in 4. There have been no intra- or postoperative complications.
The recanalised umbilical approach is safe and allows for venous sampling and postoperative measurements of the portal pressure. Under local anaesthetic, the umbilical vein can be approached above the umbilicus and exteriorised if repeated transplants are required for allograft patients. and IAP.
胰岛自体移植需要进入门静脉或其分支。我们最初通过中结肠或右结肠静脉将胰岛输注到肝脏，但自 2005 年以来，我们一直使用再通的脐静脉。在此，我们介绍该技术、其优点以及早期取得的结果。
在切除胰腺并恢复胆道和肠连续性后，横断圆韧带。识别并使用 Bakes 扩张器再通已闭塞的脐静脉，以便进入左门静脉。插入 Vygon®Nutricath'S'11-Fr 导管并用于胰岛输注。如果要将圆韧带外置用于术后测量或随后的进入，则将其通过上腹的 10mm 腹腔镜端口拉出，缝合到皮肤上并用敷料覆盖。
我们在 17 名患者中使用了这种方法，并外置了镰状韧带 4 例。没有出现术中或术后并发症。
再通的脐静脉入路是安全的，允许进行静脉采样和术后门静脉压力测量。在局部麻醉下，可以在脐上方接近脐静脉，并在外置后再次进入，对于同种异体移植患者，可能需要重复移植。
