Wahoff D C, Papalois B E, Najarian J S, Kendall D M, Farney A C, Leone J P, Jessurun J, Dunn D L, Robertson R P, Sutherland D E
Department of Surgery, University of Minnesota, Minneapolis, USA.
Ann Surg. 1995 Oct;222(4):562-75; discussion 575-9. doi: 10.1097/00000658-199522240-00013.
Extensive pancreatic resection for small-duct chronic pancreatitis is often required for pain relief, but the risk of diabetes is a major deterrent.
Incidence of pain relief, prevention of diabetes, and identification of factors predictive of success were the goals in this series of 48 patients who underwent pancreatectomy and islet autotransplantation for chronic pancreatitis.
Of the 48 patients, 43 underwent total or near-total (> 95%) pancreatectomy and 5 underwent partial pancreatectomy. The resected pancreas was dispersed by either old (n = 26) or new (n = 22) methods of collagenase digestion. Islets were injected into the portal vein of 46 of the 48 patients and under the kidney capsule in the remaining 2. Postoperative morbidity, mortality, pain relief, and need for exogenous insulin were determined, and actuarial probability of postoperative insulin independence was calculated based on several variables.
One perioperative death occurred. Surgical complications occurred in 12 of the 48 patients (25%): of these, 3 had a total (n = 27); 8, a near-total (n = 16); and 1, a partial pancreatectomy (p = 0.02). Most of the 48 patients had a transient increase in portal venous pressure after islet infusion, but no serious sequelae developed. More than 80% of patients experienced significant pain relief after pancreatectomy. Of the 39 patients who underwent total or near-total pancreatectomy, 20 (51%) were initially insulin independent. Between 2 and 10 years after transplantation, 34% were insulin independent, with no grafts failing after 2 years. The main predictor of insulin independence was the number of islets transplanted (of 14 patients who received > 300,000 islets, 74% were insulin independent at > 2 years after transplantation). In turn, the number of islets recovered correlated with the degree of fibrosis (r = -0.52, p = 0.006) and the dispersion method (p = 0.005).
Pancreatectomy can relieve intractable pain caused by chronic pancreatitis. Islet autotransplantation is safe and can prevent long-term diabetes in more than 33% of patients and should be an adjunct to any pancreatic resection. A given patient's probability of success can be predicted by the morphologic features of the pancreas.
对于小导管慢性胰腺炎，广泛的胰腺切除术常是缓解疼痛所必需的，但糖尿病风险是一个主要阻碍因素。
本系列48例因慢性胰腺炎接受胰腺切除术和胰岛自体移植的患者，目标是缓解疼痛的发生率、预防糖尿病以及确定预测成功的因素。
48例患者中，43例行全胰或近全胰（>95%）切除术，5例行部分胰腺切除术。切除的胰腺通过旧的（n = 26）或新的（n = 22）胶原酶消化方法进行分散处理。48例患者中有46例将胰岛注入门静脉，其余2例注入肾包膜下。确定术后发病率、死亡率、疼痛缓解情况以及对外源性胰岛素的需求，并根据多个变量计算术后胰岛素自主的精算概率。
发生1例围手术期死亡。48例患者中有12例（25%）出现手术并发症：其中，3例接受全胰切除术（n = 27）；8例接受近全胰切除术（n = 16）；1例接受部分胰腺切除术（p = 0.02）。48例患者中大多数在胰岛输注后门静脉压力有短暂升高，但未出现严重后遗症。超过80%的患者在胰腺切除术后疼痛得到显著缓解。在39例行全胰或近全胰切除术的患者中，20例（51%）最初胰岛素自主。移植后2至10年，34%的患者胰岛素自主，2年后无移植物失败。胰岛素自主的主要预测因素是移植的胰岛数量（在14例接受>300,000个胰岛的患者中，74%在移植后>2年胰岛素自主）。反过来，回收的胰岛数量与纤维化程度相关（r = -0.52，p = 0.006）以及分散方法相关（p = 0.005）。
胰腺切除术可缓解慢性胰腺炎引起的顽固性疼痛。胰岛自体移植是安全的，能使超过33%的患者预防长期糖尿病，应作为任何胰腺切除术的辅助手段。通过胰腺的形态学特征可预测特定患者的成功概率。
