Quality of Life Improves for Pediatric Patients After Total Pancreatectomy and Islet Autotransplant for Chronic Pancreatitis
Quality of Life Improves for Pediatric Patients After Total Pancreatectomy and Islet Autotransplant for Chronic Pancreatitis
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DOI：
10.1016/j.cgh.2011.04.024
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发表时间：
2011-09-01
影响因子：
12.6
通讯作者：
Sutherland, David E. R.
中科院分区：
文献类型：
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作者：
Bellin, Melena D.;Freeman, Martin L.;Sutherland, David E. R.
背景和目的：全胰腺切除术（TP）和胰岛自体移植（IAT）已被用于治疗患有疼痛性慢性胰腺炎的患者。初步研究表明，大多数患者的疼痛得到显着缓解，但几乎没有经过验证的生活质量衡量标准。我们调查了接受 TP/IAT 的儿科患者的健康相关生活质量是否有所改善。方法：2006 年 12 月至 2009 年 12 月期间，连续 19 名在明尼苏达大学接受 TP/IAT 的儿童（5-18 岁）在手术前后完成了医疗结果研究 36 项简表（SF36）健康问卷。记录胰岛素需求。结果：根据医疗结果研究 SF-36 的数据，在 TP/IAT 之前，患者的健康相关生活质量低于平均水平；他们的平均身体成分总结 (PCS) 分数为 30 分，心理成分总结 (MCS) 分数为 34 分（分别低于美国人口平均值 2 和 1.5 个标准差）。术后 1 年，PCS 和 MCS 评分分别提高至 50 和 46（整体效应，PCS P < .001，MCS P = .06）。所有 8 个分量表的平均分数均有所提高。超过 60% 的 IAT 接受者不依赖胰岛素或需要最少的胰岛素。既往接受过外科引流手术 (Puestow) 的患者胰岛产量较低 (P = .01)，胰岛素依赖发生率较高 (P = .04)。结论：TP/IAT 治疗后，重症慢性胰腺炎儿科患者的生活质量（身体和情感成分）显着改善。尽管之前接受过引流手术的患者胰岛产量有所减少，但大多数患者只需要很少的胰岛素或不需要胰岛素。
BACKGROUND & AIMS: Total pancreatectomy (TP) and islet autotransplant (IAT) have been used to treat patients with painful chronic pancreatitis. Initial studies indicated that most patients experienced significant pain relief, but there were few validated measures of quality of life. We investigated whether health-related quality of life improved among pediatric patients undergoing TP/IAT. METHODS: Nineteen consecutive children (aged 5-18 years) undergoing TP/IAT from December 2006 to December 2009 at the University of Minnesota completed the Medical Outcomes Study 36-item Short Form (SF36) health questionnaire before and after surgery. Insulin requirements were recorded. RESULTS: Before TP/IAT, patients had below average health-related quality of life, based on data from the Medical Outcomes Study SF-36; they had a mean physical component summary (PCS) score of 30 and mental component summary (MCS) score of 34 (2 and 1.5 standard deviations, respectively, below the mean for the US population). By 1 year after surgery, PCS and MCS scores improved to 50 and 46, respectively (global effect, PCS P < .001, MCS P = .06). Mean scores improved for all 8 component subscales. More than 60% of IAT recipients were insulin independent or required minimal insulin. Patients with prior surgical drainage procedures (Puestow) had lower yields of islets (P = .01) and greater incidence of insulin dependence (P = .04). CONCLUSIONS: Quality of life (physical and emotional components) significantly improve after TP/IAT in subsets of pediatric patients with severe chronic pancreatitis. Minimal or no insulin was required for most patients, although islet yield was reduced in patients with previous surgical drainage operations.