全胰切除联合胰岛自体移植术后慢性胰腺炎患者的疼痛控制、血糖控制及生活质量：初步报告

Pain Control, Glucose Control, and Quality of Life in Patients With Chronic Pancreatitis After Total Pancreatectomy With Islet Autotransplantation: A Preliminary Report.

作者信息

Solomina J, Gołębiewska J, Kijek M R, Kotukhov A, Bachul P J, Basto L, Gołąb K, Konsur E, Cieply K, Fillman N, Wang L-J, Thomas C C, Philipson L H, Tibudan M, Dębska-Ślizień A, Fung J, Gelrud A, Matthews J B, Witkowski P

机构信息

Department of Surgery, University of Chicago, Chicago, USA.

Department of Surgery, University of Chicago, Chicago, USA; Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland.

出版信息

Transplant Proc. 2017 Dec;49(10):2333-2339. doi: 10.1016/j.transproceed.2017.10.010.

DOI:10.1016/j.transproceed.2017.10.010

PMID:29198673

Abstract

BACKGROUND

Total pancreatectomy (TP) is offered as a last treatment option for pain relief in patients with chronic pancreatitis. Concurrent islets autotransplantation (TP-IAT) may improve glucose control.

METHODS

We analyzed results in 20 recent patients who underwent TP-IAT at The University of Chicago. The median observation period was 28 months (2-38). Data were collected prospectively then analyzed retrospectively.

RESULTS

The number of patients requiring opioids daily for pain control decreased from 16 (80%) prior to surgery to 2 (13%) 1 year after, with only 1 (6.5%) patient experiencing persistent phantom pancreatic pain. Opioid requirements decreased from a median 56.3 (0-240) morphine equivalent dose to 5 (0-130) on day 75 and to 0 (0-30) at 1-year follow up. Five patients (25%) completely stopped insulin support prior to day 75 while maintaining hemoglobin A1c of 5.9% (5-6.3). Eight (53%) patients were insulin free at 1 year with A1c of 6% (5.5-6.8) and a similar rate persisted in next 2 years. For the remaining patients, the more islet function that was preserved, the less insulin they required and A1c was closer to optimal. Quality of Life (QoL) measured by SF36 Physical (PCS) and Mental (MCS) Component Score improved on day 75 (P < .001) and maintained improvement later on. Both PCS and MCS improved regardless of whether patient requires insulin support or not.

CONCLUSIONS

Improvements of QoL with pain resolution and good glucose control can be achieved after TP-IAT in properly selected patients with CP and intractable pain, regardless of patient insulin support status.

摘要

背景

全胰切除术（TP）是慢性胰腺炎患者缓解疼痛的最后一种治疗选择。同期胰岛自体移植（TP-IAT）可能改善血糖控制。

方法

我们分析了芝加哥大学最近20例接受TP-IAT患者的结果。中位观察期为28个月（2 - 38个月）。数据前瞻性收集，然后进行回顾性分析。

结果

每日需要阿片类药物控制疼痛的患者数量从术前的16例（80%）降至术后1年的2例（13%），只有1例（6.5%）患者经历持续性胰腺幻痛。阿片类药物需求量从第75天时的中位56.3（0 - 240）吗啡当量剂量降至5（0 - 130），1年随访时降至0（0 - 30）。5例（25%）患者在第75天前完全停止胰岛素支持，同时糖化血红蛋白维持在5.9%（5 - 6.3）。8例（53%）患者在1年时无需胰岛素，糖化血红蛋白为6%（5.5 - 6.8），且在接下来2年中维持相似比例。对于其余患者，保留的胰岛功能越多，所需胰岛素越少，糖化血红蛋白越接近最佳值。用SF36身体（PCS）和精神（MCS）成分评分衡量的生活质量（QoL）在第75天有所改善（P < .001），且之后保持改善。无论患者是否需要胰岛素支持，PCS和MCS均有所改善。