Intraoperative ultrasound examination is useful for monitoring transplanted islets: a case report.
Intraoperative ultrasound examination is useful for monitoring transplanted islets: a case report.
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作者：
Sakata N;Goto M;Gumpei Y;Mizuma M;Motoi F;Satomi S;Unno M
一名 39 岁男性因慢性胰腺炎出现胰腺出血，接受全胰腺切除联合胰岛自体移植（TP with IAT）。进行术中超声（US）检查以检测移植的胰岛并评估超声成像的质量。 从切除的总胰腺中进行胰岛分离，获得约 230,000 胰岛当量 (IEQ)（组织体积为 600 µL，纯度为 30%）。用于移植和监测门静脉压力的双腔导管经肠系膜上静脉插入门静脉，导管尖端位于门静脉前后支分叉处，选择性地将胰岛注入肝右叶，以防止全肝栓塞。移植同时开始术中超声检查（中心频率 7.5 MHz，Nemio™ XG，东芝医疗系统有限公司）。 超声检查显示移植的胰岛呈高回声簇状，从导管尖端流向门静脉周围。超声检查未发现门静脉血栓或出血，移植过程中门静脉压力也未升高。 总之，我们成功地利用超声实现了人类胰岛的可视化，这使我们能够安全地进行胰岛移植。高回声图像被认为是有活力的胰岛。术中超声检查可用于在临床环境中检测移植时的胰岛。
A 39-y-old man, who had an episode of pancreatic bleeding due to chronic pancreatitis, received total pancreatectomy with islet autotransplantation (TP with IAT). Intraoperative ultrasound (US) examination was done to detect transplanted islets and evaluate the quality of US imaging. Islet isolation from the resected total pancreas was performed and approximately 230,000 islet equivalents (IEQ) (the tissue volume was 600 µL and the purity was 30%) were acquired. A double lumen catheter, used for transplantation and for monitoring the portal vein pressure, was inserted into the portal vein via the superior mesenteric vein, and the tip of the catheter was positioned at the bifurcation of the anterior and posterior branch of the portal vein to selectively infuse the islets into the right lobe of the liver in order to prevent total liver embolization. Intraoperative US examination (central frequency 7.5 MHz, Nemio™ XG, Toshiba Medical System Co.) was started at the same time as the transplantation. US examination revealed the transplanted islets as hyperechoic clusters that flowed from the tip of the catheter to the periphery of the portal vein. There were no findings of portal thrombosis or bleeding in the US image, and also no increase of the portal vein pressure during transplantation. In conclusion, we succeeded in visualizing human islets using US, which enabled us to perform islet transplantation safely. The hyperechoic images were considered to be viable islets. Intraoperative US examination can be useful for detecting islets at transplantation in a clinical setting.
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