Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, the Netherlands.
Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, the Netherlands.
Surgery. 2019 Sep;166(3):263-270. doi: 10.1016/j.surg.2019.03.014. Epub 2019 May 10.
The rationale for total pancreatectomy in painful, treatment refractory, chronic pancreatitis is pain control. Concomitant islet cell autotransplantation can prevent the loss of islet cell function. This study aimed to systematically examine the impact of total pancreatectomy with islet cell autotransplantation on pain and quality of life.
This meta-analysis was conducted according the Meta-analyses of Observational Studies in Epidemiology guideline. The Cochrane Library, PubMed, and Embase were searched for the following terms (1990 through April 2018): total pancreatectomy and chronic pancreatitis. Studies were included when addressing total pancreatectomy with islet cell autotransplantation for chronic pancreatitis in adults. Studies that reported no data on pain, endocrine function, or quality of life were excluded. Quality was assessed using the Newcastle-Ottawa scale for evaluation of all studies.
We included 15 observational studies evaluating 1,255 patients, of whom 28% had had endoscopic and 23% operative therapy. One year after total pancreatectomy with islet cell autotransplantation, the opioid-free rate had improved from between 0% and 15% to 63% (95% CI 46-77), and the insulin-free rate had decreased from between 89.5% and 100% to 30% (95% CI 20-43). An alcoholic etiology was associated with a lesser insulin-free rate after total pancreatectomy with islet cell autotransplantation. Quality of life improved statistically after total pancreatectomy with islet cell autotransplantation. Publication bias was present for both opioid and insulin outcomes.
In selected patients with painful, treatment refractory, chronic pancreatitis, evidence shows that total pancreatectomy with islet cell autotransplantation is effective for pain control in almost two-thirds of patients, whereas the insulin-free rate is relatively low.
在疼痛、治疗抵抗、慢性胰腺炎中进行全胰切除术的基本原理是控制疼痛。同时进行胰岛细胞自体移植可以防止胰岛细胞功能丧失。本研究旨在系统地检查全胰切除术联合胰岛细胞自体移植对疼痛和生活质量的影响。
本荟萃分析按照观察性研究荟萃分析的流行病学指南进行。检索了 Cochrane 图书馆、PubMed 和 Embase 数据库，检索词为（1990 年至 2018 年 4 月）：全胰切除术和慢性胰腺炎。纳入的研究对象为成人慢性胰腺炎行全胰切除术联合胰岛细胞自体移植的研究。排除未报告疼痛、内分泌功能或生活质量数据的研究。采用纽卡斯尔-渥太华量表对所有研究进行质量评估。
我们纳入了 15 项观察性研究，共纳入 1255 例患者，其中 28%的患者接受过内镜治疗，23%的患者接受过手术治疗。在全胰切除术联合胰岛细胞自体移植后 1 年，阿片类药物无依赖率从 0%到 15%提高到 63%（95%CI 46-77），胰岛素无依赖率从 89.5%到 100%下降到 30%（95%CI 20-43）。全胰切除术联合胰岛细胞自体移植后，酒精性病因与胰岛素无依赖率降低相关。全胰切除术联合胰岛细胞自体移植后生活质量有统计学上的改善。阿片类药物和胰岛素结局均存在发表偏倚。
在患有疼痛、治疗抵抗、慢性胰腺炎的选定患者中，证据表明，全胰切除术联合胰岛细胞自体移植对近三分之二的患者有效，可控制疼痛，而胰岛素无依赖率相对较低。
