Rossi R L, Soeldner J S, Braasch J W, Heiss F W, Shea J A, Watkins E, Silverman M L
Department of General Surgery, Lahey Clinic Medical Center, Burlington, Massachusetts 01805.
Am J Surg. 1990 Jan;159(1):51-7; discussion 57-8. doi: 10.1016/s0002-9610(05)80606-3.
Thirteen patients who underwent extensive pancreatic resection and segmental autotransplantation and who have a median follow-up of 62 months are presented. Eleven patients had technically successful grafts. Three of six patients who underwent total pancreatectomy and three of five patients who underwent near-total resection remain insulin-independent. Those patients who require insulin require small doses and have stable diabetes. Pain has recurred in 7 of the 11 patients who underwent distal subtotal resection; 5 of them required pancreatoduodenectomy and completion pancreatectomy for pain relief. Because of the high rate of recurrence of pain after distal resection, we favor pancreatoduodenectomy as the initial procedure of choice. When distal near-total or total pancreatectomy is required, the addition of segmental autotransplantation offers definitive, although at times transient, benefits in glucose homeostasis compared with no transplantation.
本文报告了13例接受广泛胰腺切除术和节段性自体移植的患者，他们的中位随访时间为62个月。11例患者的移植在技术上取得成功。6例接受全胰切除术的患者中有3例，5例接受近全切除术的患者中有3例仍无需胰岛素治疗。那些需要胰岛素的患者所需剂量较小，且糖尿病病情稳定。11例接受远端次全切除术的患者中有7例疼痛复发；其中5例需要行胰十二指肠切除术和全胰切除术以缓解疼痛。由于远端切除术后疼痛复发率较高，我们倾向于将胰十二指肠切除术作为首选的初始手术。当需要进行远端近全或全胰切除术时，与不进行移植相比，加行节段性自体移植在血糖稳态方面可提供明确的益处，尽管有时是短暂的。
