Total pancreatectomy: Indications, operative technique, and postoperative sequelae
Total pancreatectomy: Indications, operative technique, and postoperative sequelae
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DOI：
10.1007/s11605-006-0025-7
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发表时间：
2007-02-01
影响因子：
3.2
通讯作者：
Simeone, Diane M.
中科院分区：
文献类型：
--
作者：
Heidt, David G.;Burant, Charles;Simeone, Diane M.
全胰腺切除术已被用于治疗胰腺的良、恶性疾病，但由于对胰腺状态的处理及其伴随的总内分泌和外分泌不足的担忧，其应用受到限制。在这里，我们回顾了全胰腺切除的适应证，手术技巧，以及患者术后管理的改进。全胰腺切除仍然是治疗慢性胰腺炎、多中心或广泛神经内分泌肿瘤、伴有癌前病变的家族性胰腺癌患者以及伴有弥漫性导管侵犯或侵袭性疾病的导管内乳头状黏液瘤患者的可行选择。术后管理的改进包括自体胰岛细胞移植，胰岛素配方的进步，以及高血糖素抢救疗法的使用，这种疗法允许比以前更严格地控制血糖。这显著降低了危及生命的低血糖的风险，降低了长期并发症的风险，从而改善了这些患者的生活质量。
Total pancreatectomy has been used to treat both benign and malignant disease of the pancreas, but its use has been limited by concerns about management of the apancreatic state with its attendant total endocrine and exocrine insufficiency. Here, we review the indications for total pancreatectomy, operative technique, and improvements in the postoperative management of patients. Total pancreatectomy remains a viable option in the treatment of intractable pain associated with chronic pancreatitis, multicentric or extensive neuroendocrine tumors, patients with familial pancreatic cancer with premalignant lesions, and in patients with intraductal papillary mucinous neoplasia with diffuse ductal involvement or invasive disease. Improvements in postoperative management include auto-islet cell transplantation, advances in insulin formulations, and the use of glucagon rescue therapy which allow much tighter control of blood glucose than previously possible. This markedly lessens the risk of life-threatening hypoglycemia and decreases the risk of long-term complications, resulting in improved quality of life for these patients.