Robertson G S, Dennison A R, Johnson P R, London N J
Department of Surgery, Leicester University, UK.
Hepatogastroenterology. 1998 Jan-Feb;45(19):226-35.
The current literature suggests that following either total or subtotal pancreatectomy for chronic pancreatitis, the intraportal infusion of the purified or unpurified pancreatic digest will render approximately 50% of patients insulin independent. Early reports suggested that such a procedure might result in hepatic infarction and coagulopathies, but there have been no such complications in the last decade, suggesting that autotransplantation is now associated with low morbidity and mortality. There is an acknowledged subsequent rate of graft failure, but successful long-term insulin independence has now been documented for more than 10 years (Table 1). All centers undertaking total pancreatectomy for benign conditions should examine the possibility of islet autotransplantation, since even a background level of glucose responsiveness is likely to facilitate postoperative management considerably in this difficult group of patients. The process of pancreas dispersion and islet purification should probably be performed in specialist centers with a good understanding of the problems outlined above. While the transport of the pancreas and islets to and from such centers is possible in theory, we suggest that referral of the patient to a specialist center experienced in the surgical technique, transplantation and postoperative management of these patients might be more appropriate.
目前的文献表明，对于慢性胰腺炎患者，无论是行全胰切除术还是胰次全切除术，门静脉内输注纯化或未纯化的胰酶消化液可使约50%的患者不再依赖胰岛素。早期报告提示，该操作可能导致肝梗死和凝血功能障碍，但在过去十年中未出现此类并发症，这表明自体移植目前的发病率和死亡率较低。虽然公认存在移植物失败率，但目前已有成功实现长期胰岛素非依赖超过10年的记录（表1）。所有因良性疾病而行全胰切除术的中心都应考虑胰岛自体移植的可能性，因为即使是基础水平的葡萄糖反应性也可能极大地促进这类困难患者的术后管理。胰腺分散和胰岛纯化过程可能应在充分了解上述问题的专业中心进行。虽然理论上胰腺和胰岛可以在这样的中心之间运输，但我们建议将患者转诊至在这些患者的手术技术、移植及术后管理方面经验丰富的专业中心可能更为合适。
