Najarian J S, Sutherland D E, Baumgartner D, Burke B, Rynasiewicz J J, Matas A J, Goetz F C
Ann Surg. 1980;192(4):526-42. doi: 10.1097/00000658-198010000-00011.
Total or near total pancreatectomy is the surest way to relieve the pain of chronic pancreatitis but is rarely applied because the metabolic consequences are so severe. For most patients drainage procedures are applicable, but pancreatectomy may be the only alternative for small duct disease or where procedures to improve duct drainage have failed. Preservation of endocrine function is a major problem in patients who require pancreatectomy. Experiments in pancreatectomized dogs have shown that intrasplenic or intraportal transplantation of unpurified pancreatic islet tissue dispersed by collagenase digestion can prevent diabetes. We have applied this technique to ten patients with chronic pancreatitis, small ducts, and intractable pain. The entire pancreas of > 95% of the pancrease was excised, minced, dispersed by collagenase digestion and infused into the portal vein < 2 1/2 hours after removal. Mean (+/- SD) rise in portal pressure was 17 +/- 8 cm of water. Liver function tests were altered minimally. All patients were relieved of pain. One patient died of a complication not related to the islet autotransplant; viable islets were identified in the liver at autopsy. Of the remaining nine patients, three have been insulin independent for 1, 9, and 38 months. One patient was insulin indpendent for 15 months and now takes 12 units of insulin daily. Three have nonketosis prone diabetes (tested by insulin withdrawal) and take 15--30 units of insulin per day. C-peptide studies in these patients show that functioning islets are present. Two patients are diabetic and require 35 and 60 units of insulin per day. In eight of nine patients tested serum insulin concentrations fell to undetectable levels during the interval between pancreatectomy and islet transplantation. Serum insulin levels during the first few hours after islet transplantation predicted success. In the insulin independent or in the patients with mild diabetes, insulin levels were persistently greater than or equal to 6 microU/ml. In the other two patients, the increase in insulin concentration was not sustained. Islet tissue preparation from a diseased pancreas is difficult. The surgeon and the patient must still be willing to accept diabetes for relief of pain when performing this operation. In some patients, however, islet autotransplantation can prevent or partially ameliorate diabetes after pancreatectomy, and preservation of endocrine function is worthwhile.
全胰切除术或近全胰切除术是缓解慢性胰腺炎疼痛最可靠的方法，但很少应用，因为其代谢后果非常严重。对于大多数患者而言，引流手术是可行的，但对于小导管疾病或改善导管引流的手术失败的情况，胰切除术可能是唯一的选择。对于需要进行胰切除术的患者，保留内分泌功能是一个主要问题。对胰腺切除的狗进行的实验表明，通过胶原酶消化分散的未纯化胰岛组织进行脾内或门静脉内移植可以预防糖尿病。我们已将此技术应用于10例患有慢性胰腺炎、小导管和顽固性疼痛的患者。切除了超过95%的胰腺，切碎，经胶原酶消化分散，并在切除后不到2个半小时内注入门静脉。门静脉压力平均（±标准差）升高17±8厘米水柱。肝功能检查仅有轻微改变。所有患者的疼痛均得到缓解。1例患者死于与胰岛自体移植无关的并发症；尸检时在肝脏中发现了存活的胰岛。其余9例患者中，3例已分别在1个月、9个月和38个月内无需胰岛素治疗。1例患者曾在15个月内无需胰岛素治疗，现在每天注射12单位胰岛素。3例有非酮症倾向糖尿病（通过停用胰岛素检测），每天注射15 - 30单位胰岛素。对这些患者进行的C肽研究表明存在有功能的胰岛。2例患者患有糖尿病，每天需要35和60单位胰岛素。在接受检测的9例患者中的8例中，血清胰岛素浓度在胰切除术和胰岛移植之间的间隔期降至无法检测的水平。胰岛移植后最初几个小时的血清胰岛素水平可预测手术是否成功。在无需胰岛素治疗或患有轻度糖尿病的患者中，胰岛素水平持续大于或等于6微单位/毫升。在另外2例患者中，胰岛素浓度的升高未持续。从患病胰腺制备胰岛组织很困难。在进行此手术时，外科医生和患者仍必须愿意接受糖尿病以缓解疼痛。然而，在一些患者中，胰岛自体移植可以预防或部分改善胰切除术后的糖尿病，并且保留内分泌功能是值得的。
