Bellin Melena D, Forlenza Gregory P, Majumder Kaustav, Berger Megan, Freeman Martin L, Beilman Gregory J, Dunn Ty B, Pruett Timothy L, Murati Michael, Wilhelm Joshua J, Cook Marie, Sutherland David E R, Schwarzenberg Sarah J, Chinnakotla Srinath
*Department of Pediatrics†Department of Surgery‡Department of Radiology§Department of Medicine, University of Minnesota and Masonic Children's Hospital, Minneapolis, MN¶Barbara Davis Center for Childhood Diabetes, University of Colorado Denver, Denver, CO.
J Pediatr Gastroenterol Nutr. 2017 Mar;64(3):440-445. doi: 10.1097/MPG.0000000000001314.
Fear of diabetes and major surgery may prohibit referral of young children severely affected by pancreatitis for total pancreatectomy with islet autotransplant (TPIAT). We evaluated outcomes in our youngest TPIAT recipients, 3 to 8 years of age at surgery.
Medical records were reviewed for 17 children (9 girls) ages 8 years or younger undergoing TPIAT from 2000 to 2014. Most (14/17) had genetic risk factors for pancreatitis. Since 2006, TPIAT recipients were followed prospectively with health questionnaires including assessments of pain and narcotic use, and scheduled hemoglobin A1c (HbA1c) and mixed-meal tolerance tests (6 mL/kg Boost HP) before surgery, and at regular intervals after. Patients are 1 to 11 years post-TPIAT (median 2.2 years). Data are reported as median (25th, 75th percentile).
All had relief of pain, with all 17 patients off narcotics at most recent follow-up. Hospitalization rates decreased from 5.0 hospitalization episodes per person-year of follow-up before TPIAT, to 0.35 episodes per person-year of follow-up after TPIAT. Fourteen (82%) discontinued insulin, higher than the observed insulin independence rate of 41% in 399 patients older than 8 years of age undergoing TPIAT over the same interval (P = 0.004). Median post-TPIAT HbA1c was 5.9% (5.6%, 6.3%), and within patient post-TPIAT mean HbA1c was ≤6.5% for all but 2 patients.
Young children with severe refractory chronic pancreatitis may be good candidates for TPIAT, with high rates of pain relief and insulin independence, and excellent glycemic control in the majority.
对糖尿病和大手术的恐惧可能会阻碍将受胰腺炎严重影响的幼儿转诊接受全胰切除加自体胰岛移植（TPIAT）。我们评估了最年轻的TPIAT接受者（手术时年龄为3至8岁）的治疗结果。
回顾了2000年至2014年间17例8岁及以下接受TPIAT的儿童（9名女孩）的病历。大多数（14/17）有胰腺炎的遗传风险因素。自2006年以来，对TPIAT接受者进行前瞻性随访，采用健康问卷，包括疼痛和麻醉药物使用评估，并在手术前及术后定期安排糖化血红蛋白（HbA1c）和混合餐耐量试验（6 mL/kg Boost HP）。患者在TPIAT术后1至11年（中位时间2.2年）。数据报告为中位数（第25、75百分位数）。
所有患者疼痛均得到缓解，在最近一次随访时所有17例患者均停用了麻醉药物。住院率从TPIAT前每人每年5.0次住院发作，降至TPIAT后每人每年0.35次发作。14例（82%）停用了胰岛素，高于同期399例8岁以上接受TPIAT患者41%的胰岛素停用率（P = 0.004）。TPIAT术后HbA1c中位数为5.9%（5.6%，6.3%），除2例患者外，所有患者TPIAT术后平均HbA1c均≤6.5%。
患有严重难治性慢性胰腺炎的幼儿可能是TPIAT的良好候选者，疼痛缓解率和胰岛素停用率高，大多数患者血糖控制良好。
