McEachron Kendall R, Bellin Melena D
Department of Surgery.
Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota, USA.
Curr Opin Gastroenterol. 2018 Sep;34(5):367-373. doi: 10.1097/MOG.0000000000000458.
We reviewed the current state of total pancreatectomy with islet autotransplantation (TPIAT) for chronic pancreatitis and recurrent acute pancreatitis (RAP).
An increasing number of centers in the United States and internationally are performing TPIAT. In selected cases, TPIAT may be performed partially or entirely laparoscopically. Islet isolation is usually performed at the same center as the total pancreatectomy surgery, but new data suggest that diabetes outcomes may be nearly as good when a remote center is used for islet isolation. Ongoing clinical research is focused on patient and disease factors that predict success or failure to respond to TPIAT. Causes of persistent abdominal pain after TPIAT may include gastrointestinal dysmotility and central sensitization to pain. Several clinical trials are underway with anti-inflammatory or other islet protective strategies to better protect islets at the time of infusion and thereby improve the diabetes results of the procedure.
In summary, there is an increasing body of literature emerging from multiple centers highlighting the benefits and persistent challenges of TPIAT for chronic pancreatitis and RAP. Ongoing study will be critical to optimizing the success of this procedure.
我们回顾了全胰切除术加胰岛自体移植（TPIAT）治疗慢性胰腺炎和复发性急性胰腺炎（RAP）的现状。
美国和国际上越来越多的中心开展TPIAT。在某些病例中，TPIAT可部分或全部通过腹腔镜进行。胰岛分离通常在与全胰切除术相同的中心进行，但新数据表明，当使用远程中心进行胰岛分离时，糖尿病治疗效果可能几乎相同。正在进行的临床研究聚焦于预测TPIAT成功或失败的患者和疾病因素。TPIAT后持续腹痛的原因可能包括胃肠动力障碍和对疼痛的中枢敏化。正在进行多项抗炎或其他胰岛保护策略的临床试验，以在输注时更好地保护胰岛，从而改善该手术的糖尿病治疗效果。
总之，多个中心涌现出越来越多的文献，强调了TPIAT治疗慢性胰腺炎和RAP的益处及持续存在的挑战。持续研究对于优化该手术的成功率至关重要。
