Total Pancreatectomy With Islet Autotransplantation Resolves Pain in Young Children With Severe Chronic Pancreatitis.
Total Pancreatectomy With Islet Autotransplantation Resolves Pain in Young Children With Severe Chronic Pancreatitis.
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DOI：
10.1097/mpg.0000000000001314
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发表时间：
2017-03
影响因子：
2.9
通讯作者：
Chinnakotla S
中科院分区：
文献类型：
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作者：
Bellin MD;Forlenza GP;Majumder K;Berger M;Freeman ML;Beilman GJ;Dunn TB;Pruett TL;Murati M;Wilhelm JJ;Cook M;Sutherland DE;Schwarzenberg SJ;Chinnakotla S
对糖尿病和大手术的恐惧可能会阻止因胰腺炎严重影响的幼儿进行全胰腺切除术和胰岛自体移植（TPIAT）。我们评估了我们最年轻的TPIAT接受者的结局，手术时年龄为3-8岁。审查了2000-2014年接受TPIAT的17名年龄≤8岁儿童（9名女性）的病历。大多数（14/17）有胰腺炎的遗传风险因素。自2006年以来，对TPIAT接受者进行了前瞻性的健康问卷调查，包括疼痛和麻醉剂使用的评估，以及术前和术后定期进行的HbA 1c和混合餐耐量试验（6 mL/kg Boost HP）。患者TPIAT后1-11年（中位数2.2年）。数据报告为中位数（第25、75百分位数）。所有患者的疼痛均得到缓解，所有17名患者在最近的随访中均停用了麻醉剂。住院率从TPIAT前随访的5.0次住院事件/人年下降到TPIAT后随访的0.35次住院事件/人年。14例（82%）患者停用胰岛素，高于399例在相同时间间隔内接受TPIAT的>8岁患者中观察到的41%的胰岛素依赖率（p=0.004）。TPIAT后中位HbA 1c为5.9%（5.6，6.3%），除2例患者外，所有患者的TPIAT后平均HbA 1c均≤6.5%。患有严重难治性慢性胰腺炎的非常年幼的儿童可能是TPIAT的良好候选者，其疼痛缓解率和胰岛素依赖性较高，并且大多数患者血糖控制良好。
Fear of diabetes and major surgery may prohibit referral of young children severely impacted by pancreatitis for total pancreatectomy and islet autotransplant (TPIAT). We evaluated outcomes in our youngest TPIAT recipients, age 3–8 years at surgery. Medical records were reviewed for 17 children (9 female) age ≤8 years undergoing TPIAT from 2000–2014. Most (14/17) had genetic risk factors for pancreatitis. Since 2006, TPIAT recipients were followed prospectively with health questionnaires including assessments of pain and narcotic use, and scheduled HbA1c and mixed meal tolerance tests (6 mL/kg Boost HP) before surgery, and at regular intervals after. Patients are 1–11 years post TPIAT (median 2.2 years). Data are reported as median (25th, 75th percentile). All had relief of pain, with all 17 patients off narcotics at most recent follow up. Hospitalization rates decreased from 5.0 hospitalization episodes per person-year of follow up before TPIAT, to 0.35 episodes per person-year of follow up after TPIAT. Fourteen (82%) discontinued insulin, higher than the observed insulin independence rate of 41% in 399 patients >8 years of age undergoing TPIAT over the same interval (p=0.004). Median post-TPIAT HbA1c was 5.9% (5.6, 6.3%), and within patient post-TPIAT mean HbA1c was ≤6.5% for all but 2 patients. Very young children with severe refractory chronic pancreatitis may be good candidates for TPIAT, with high rates of pain relief and insulin independence, and excellent glycemic control in the majority.