全胰切除术联合胰岛自体移植（TPIAT）作为治疗慢性特发性胰腺炎的一种技术：早期经验分析
Total Pancreatectomy with Islet Autotransplantation (TPIAT) as a Technique to Treat Chronic Idiopathic Pancreatitis: Early Experience Analysis.
作者信息
Zagainov V E, Kuchin D M, Kashina A V, Lugovaya L A, Zarechnova N V, Galanina T A, Naraliev N U, Kolesnik Y I, Vasilchikova E A, Ermakova P S, Zagaynov E M, Kucheryavy Yu A, Bogomolova A Yu, Potapov A L, Shirokova I Yu
机构信息
MD, DSc, Director of the Institute of Surgery and Oncology; Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia; Head of the Department of Faculty Surgery and Transplantology; Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia; Deputy Chief Physician for Science and Innovation; Nizhny Novgorod Regional Oncologic Dispensary, 11/1 Delovaya St., Nizhny Novgorod, 603093, Russia.
MD, PhD, Associate Professor, Department of Faculty Surgery and Transplantology; Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia; Head of the Center for Abdominal Surgery; Nizhny Novgorod Regional Clinical Hospital named after N.A. Semashko, 190 Rodionova St., Nizhny Novgorod, 603093, Russia.
出版信息
Sovrem Tekhnologii Med. 2024;16(6):44-56. doi: 10.17691/stm2024.16.6.05. Epub 2024 Dec 27.
UNLABELLED
Chronic pancreatitis (CP) is a quite common disease with an annual incidence of up to 30 new cases per 100,000 persons in Russia, and 9.6 cases per 100,000 persons abroad. Idiopathic pancreatitis associated with genetic mutations ranks second in frequency. When conservative therapy is ineffective, surgical intervention is considered. Total pancreatectomy reduces pain, but leads to pancreatogenic diabetes mellitus. In case of hereditary pancreatitis caused by mutations in the , , genes, pancreatectomy becomes advisable, including for prevention of pancreatic cancer. Isolation of Langerhans islets from the excised pancreas and their autotransplantation (total pancreatectomy with islet autotransplantation, TPIAT) provides additional treatment options. Such surgical interventions are not performed in Russia as of yet. was to assess the effectiveness of total pancreatectomy followed by restoration of glucose tolerance in treatment of patients with chronic genetically determined pain pancreatitis.
MATERIALS AND METHODS
Two patients with chronic pain pancreatitis with the and genetic mutations were examined and underwent surgical total pancreatectomy. Islets were isolated from the excised glands and implanted into the liver. Postoperative followup included an assessment of quality of life and pain intensity based on questionnaires, as well as determination of the glycemic level.
RESULTS
Following total pancreatoduodenectomy and autotransplantation, a significant decrease in pain and an improvement in quality of life were noted. Transplanted islets' function was reduced, due to their insufficient number, which required administration of exogenous insulin.
CONCLUSION
The described experience demonstrates the TPIAT effectiveness in treatment of chronic pancreatitis, which can become a basis for further research and introduction of the technique into domestic clinical practice.
未标注
慢性胰腺炎（CP）是一种相当常见的疾病，在俄罗斯每年发病率高达每10万人中有30例新发病例，在国外为每10万人中有9.6例。与基因突变相关的特发性胰腺炎在发病频率上位居第二。当保守治疗无效时，考虑进行手术干预。全胰切除术可减轻疼痛，但会导致胰腺源性糖尿病。对于由 、 、 基因的突变引起的遗传性胰腺炎，全胰切除术是可取的，包括用于预防胰腺癌。从切除的胰腺中分离出朗格汉斯胰岛并进行自体移植（全胰切除加胰岛自体移植，TPIAT）提供了额外的治疗选择。截至目前，俄罗斯尚未开展此类手术干预。 旨在评估全胰切除术后恢复糖耐量对治疗慢性遗传性疼痛性胰腺炎患者的有效性。
材料与方法
对两名患有慢性疼痛性胰腺炎且有 和 基因突变的患者进行了检查，并接受了手术全胰切除术。从切除的腺体中分离出胰岛并植入肝脏。术后随访包括根据问卷评估生活质量和疼痛强度，以及测定血糖水平。
结果
全胰十二指肠切除及自体移植术后，疼痛明显减轻，生活质量得到改善。由于移植胰岛数量不足，其功能降低，这需要给予外源性胰岛素。
结论
所述经验证明了TPIAT在治疗慢性胰腺炎方面的有效性，这可为进一步研究以及将该技术引入国内临床实践奠定基础。
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