Percutaneous transhepatic pancreatic islet cell transplantation in type I diabetes mellitus: Radiologic aspects
Percutaneous transhepatic pancreatic islet cell transplantation in type I diabetes mellitus: Radiologic aspects
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DOI：
10.1148/radiol.2291021632
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发表时间：
2003-10-01
期刊：
影响因子：
19.7
通讯作者：
Shapiro, AMJ
中科院分区：
文献类型：
--
作者：
Owen, RJT;Ryan, EA;Shapiro, AMJ
目的：报告我们对 1 型糖尿病患者进行经皮肝穿刺胰岛细胞移植的经验。材料和方法：1999 年 3 月至 2002 年 5 月期间，34 名患者接受了 68 例胰岛细胞移植手术。选择 C 肽阴性 I 型糖尿病患者的依据是尽管遵守了最佳药物治疗，但代谢控制不佳（低血糖或不稳定）。胰岛细胞是从脑死亡的供体中分离出来的。通过右侧经皮肝穿刺方法进入门静脉，并通过间歇压力监测输注胰岛细胞。 20名患者接受了两次移植，7名患者接受了3次移植，7名患者接受了1次移植。监测手术期间和手术后的并发症以及手术后的糖尿病状态。结果：所有病例均成功实现门静脉插管和胰岛细胞输注。 68 例手术中有 58 例（85%）使用荧光镜作为主要指导方式，68 例中有 10 例（15%）使用超声检查。记录的总透视时间从 0.6 分钟到 103 分钟不等，中位数为 6.9 分钟。 68 例手术中有 6 例（9%）发生了潜在的严重并发症。两名患者出现门静脉血栓形成，在随后的抗凝治疗中，两人中的一名出现了扩大的肝血肿，需要手术治疗。四名患者发生了临床上严重的出血，其中三人需要输血。在接受完整移植的 26 名患者中，全部实现了胰岛素依赖，并且 81%（26 人中的 21 名）在 1 年后仍保持不依赖胰岛素。结论：经皮肝穿刺方法将胰岛细胞植入门静脉是一种安全的手术，结合使用当前的细胞分离技术和免疫抑制方案，为 1 型糖尿病的治疗提供了显着的进步。 (C) 北美放射学会，2003 年。
PURPOSE: To report our experience with percutaneous transhepatic pancreatic islet cell transplantation in patients with type 1 diabetes mellitus.MATERIALS AND METHODS: Between March 1999 and May 2002, 34 patients underwent 68 islet cell transplantation procedures. Patients with C-peptide-negative type I diabetes were selected on the basis of poor metabolic control (hypoglycemia or lability) despite compliance with optimal medical therapy. Islet cells were isolated from brain-dead donors. Access to the portal vein was gained from a right percutaneous transhepatic approach, and islet cells were infused with intermittent pressure monitoring. Twenty patients underwent two transplantations, seven patients underwent three transplantations, and seven patients underwent one transplantation. Complications during and after the procedure and postprocedural diabetic status were monitored.RESULTS: Successful portal vein cannulation and islet cell infusion were achieved in all cases. Fluoroscopy was used as the primary guidance modality in 58 of 68 (85%) procedures, and ultrasonography was used in 10 of 68 (15%). Total recorded fluoroscopy time varied from 0.6 to 103 minutes, with a median of 6.9 minutes. Potentially serious complications occurred in six of 68 (9%) procedures. Two patients developed portal venous thrombosis, and with subsequent anticoagulation therapy, one of the two developed an expanding hepatic hematoma that required surgery. Clinically important hemorrhage occurred in four patients, three of whom required blood transfusions. Of 26 patients who received completed transplants, all became insulin independent, and 81% (21 of 26) remained insulin free at 1 year.CONCLUSION: The percutaneous transhepatic approach for the implantation of islet cells into the portal vein is a safe procedure, and together with use of current cell separation techniques and an immunosuppressive regimen, offers a marked advance in the treatment of type 1 diabetes mellitus. (C) RSNA, 2003.