Pancreatectomy with islet autotransplantation for the treatment of severe chronic pancreatitis: The first 40 patients at the Leicester General Hospital
Pancreatectomy with islet autotransplantation for the treatment of severe chronic pancreatitis: The first 40 patients at the Leicester General Hospital
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DOI：
10.1097/01.tp.0000054618.03927.70
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发表时间：
2003-07-15
期刊：
影响因子：
6.2
通讯作者：
Dennison, AR
中科院分区：
文献类型：
--
作者：
Clayton, HA;Davies, JE;Dennison, AR
背景手术切除胰腺被认为是治疗慢性胰腺炎的最后手段。然而，同时进行胰岛自体移植的机会提供了预防糖尿病发作的可能性。自1994年以来，我中心一直提供胰腺切除术和胰岛自体移植。目前共有40名患者接受了这一手术。随访时间为6个月至7年。这里提供的数据包括每年的术后口服葡萄糖耐量试验和糖化血红蛋白（HbA（1c））结果，以及胰岛素和阿片类药物的需求。19名男性和21名女性患者（中位年龄44岁，范围21-65）已接受移植。45%的胰腺炎与酒精有关，40%为特发性胰腺炎。移植的胰岛当量（IEQ）中位数为130，108（24，332 -1，165，538），相当于每千克体重2，020（320- 23，311）IEQ。移植后2年，18例患者的中位HbA（1c）为6.6%（5.2-19.3%），空腹C肽为0.66 ng/mL（0.26-2.65 ng/mL），每天需要的胰岛素中位数为12（0-45）单位。6年时，这些数字分别为8%（6.1-11.1%）、1.68 ng（mL）（0.9-2.78 ng/ml）和43 U/d（6-86 U/d）。大多数患者不再需要阿片类镇痛药，68%的患者能够重返工作岗位，1例患者生了孩子。胰岛自体移植提供了一个有价值的除了手术切除胰腺，作为慢性胰腺炎的治疗;即使在情况下，胰岛素不依赖性是没有实现的，C肽的潜在的有益作用，使程序值得。
Background. Surgical resection of the pancreas is considered a final resort in the treatment of chronic pancreatitis. However, the opportunity to perform an islet autotransplant at the same time provides the potential to prevent the onset of diabetes.Methods. Pancreatectomy together with islet autotransplantation has been offered in our center since 1994. A total of 40 patients have now undergone this procedure. The follow-up times range from 6 months to 7 years. The data presented here include the annual postoperative oral glucose tolerance test and glycosylated hemoglobin (HbA(1c)) results, together with insulin and opiate requirements.Results. Nineteen male and 21 female patients (median age 44, range 21-65) have been transplanted. Pancreatitis was related to alcohol in 45% and was idiopathic in 40%. A median of 130,108 (24,332-1, 165,538) islet equivalent (IEQ) were transplanted, which related to 2,020 (320-23,311) IEQ per kilogram of body weight. At 2 years posttransplant, 18 patients had a median HbA(1c) of 6.6% (5.2-19.3%), fasting C-peptide of 0.66 ng/mL (0.26-2.65 ng/mL), and required a median of 12 (0-45) units of insulin per day. At 6 years, these figures were 8% (6.1-11.1%),1.68 ng(mL (0.9-2.78 ng/ml) and 43 U/day (6-86 U/day), respectively. The majority of patients no longer require opiate analgesia, 68% have been able to return to work, and one patient has had a baby.Conclusions. Islet autotransplantation offers a valuable addition to surgical resection of the pancreas, as a treatment for chronic pancreatitis; and even in cases in which insulin independence is not achieved, the potential beneficial effects of C-peptide make the procedure worthwhile.