Total pancreatectomy and islet autotransplantation for chronic pancreatitis.
Total pancreatectomy and islet autotransplantation for chronic pancreatitis.
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DOI：
10.1016/j.jamcollsurg.2011.12.040
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发表时间：
2012-04
影响因子：
5.2
通讯作者：
Pruett, Timothy L.
中科院分区：
文献类型：
--
作者：
Sutherland, David E. R.;Radosevich, David M.;Bellin, Melena D.;Hering, Bernard J.;Beilman, Gregory J.;Dunn, Ty B.;Chinnakotla, Srinath;Vickers, Selwyn M.;Bland, Barbara;Balamurugan, A. N.;Freeman, Martin L.;Pruett, Timothy L.
全胰切除术联合门静脉内胰岛移植术（IAT）可在其他治疗方法无效的情况下，减轻慢性胰腺炎（CP）患者的疼痛并保留胰岛细胞。报告的是一个>30年的单中心系列。409例患者1977年2月至2011年9月期间，53名5-18岁CP儿童接受了TP-IAT;（病因特发性-41%; SOD/胆道-9%;遗传-14%;分裂-17%;酒精-7%;其他-12%）;平均年龄-35.3岁）; 74%女性;既往手术21%--Puestow手术9%，维普莱切除术6%，胰尾切除术7%; 2%）。对于未接受胰岛素治疗的患者，胰岛功能分类为胰岛素非依赖性;如果已知C肽阳性或每日一次胰岛素治疗血糖正常，则为部分胰岛功能;如果接受标准基础-餐时糖尿病方案，则为胰岛素依赖性。自2007年以来，在患者进行的系列随访之前和随访中完成了SF-36生活质量（QOL）调查，2008年增加了综合调查。TP-IAT后的患者生存率成人为96%，儿童为98%（1年），89%和98%（5年）。15.9%的患者出现了需要再次剖腹手术的并发症，其中出血（9.5%）最为常见。IAT功能达到90%（C肽>0.6 ng/ml）。3年时，30%的患者不依赖胰岛素（成人25%，儿童55%），33%的患者功能不全。82%的患者平均HbA 1C <7.0%。既往胰腺手术降低了胰岛产量（2712 vs 4077/kg，p=.003）。胰岛产量[<2500/kg（36%）; 2501-5000/kg（39%）; >5000/kg（24%）]与功能程度相关，3年时胰岛素非依赖率为12、22和72%，部分功能为33、62和24%。所有患者在TP-IAT前均有疼痛，几乎所有患者均每日服用麻醉剂。TP-IAT后，85%的患者疼痛改善。两年后，59%的人停止了吸毒。所有的孩子都在麻醉剂之前，39%在随访;疼痛改善94%; 67%成为无痛。在SF-36调查中，无论是否使用麻醉剂，所有维度均较基线有显著改善，包括身体和精神成分总结（P<0.01）。TP可以改善疼痛，改善其他难治性CP患者的生活质量，即使麻醉剂戒断延迟或不完全，因为以前的长期使用。IAT在大多数患者中保留了有意义的胰岛功能，在>2/3的胰岛素依赖性患者中保留了大量胰岛功能，这些患者发生在四分之一的成人和一半的儿童中。
Total-pancreatectomy (TP) with intraportal-islet-auto-transplantation (IAT) can relieve pain and preserve beta-cell-mass in patients with chronic-pancreatitis (CP) when other-therapies fail. Reported is a >30-year-single-center-series. 409 patients (53 children, 5–18 yrs) with CP underwent TP-IAT from Feb/1977–Sept/2011; (etiology idiopathic-41%; SOD/biliary-9%; genetic-14%; divisum-17%; alcohol-7%; other-12%); mean age-35.3 yrs,); 74% female; prior-surgeries 21%--Puestow procedure 9%, Whipple 6%, distal pancreatectomy 7%; other 2%). Islet-function was classified as insulin-independent for those on no insulin; partial if known C-peptide positive or euglycemic on once-daily-insulin; and insulin-dependent if on standard basal–bolus diabetic regimen. An SF-36-survey for Quality-of-Life (QOL)) was completed before and in serial follow-up by patients done since 2007 with an integrated-survey that added in 2008. Actuarial-patient-survival post-TP-IAT was 96% in adults and 98% in children (1-year) and; 89% and 98% (5-years). Complications requiring relaparotomy occurred in 15.9%, bleeding (9.5%) being most common. IAT-function is achieved in 90% (C-peptide >0.6 ng/ml). At 3 years, 30% were insulin-independent (25% in adults, 55% in children) and 33% had partial-function. Mean HbA1C was <7.0% in 82%. Prior pancreas surgery lowered islet-yield (2712vs4077/kg, p=.003). Islet yield [<2500/kg (36%); 2501–5000/kg (39%); >5000/kg (24%)] correlated with degree of function with insulin-independent rates at 3 yrs of 12, 22 and 72%, partial function 33, 62 and 24%. All patients had pain before TP-IAT and nearly all were on daily-narcotics. After TP-IAT, 85% had pain-improvement. By two years 59% had ceased-narcotics. All children were on narcotics before, 39% at follow-up; pain improved in 94%; 67% became pain-free. In the SF-36 survey, there was significant improvement from baseline in all dimensions including the Physical and Mental Component Summaries (P<0.01), whether on narcotics or not. TP can ameliorate pain and improve QOL in otherwise-refractory-CP-patients, even if narcotic-withdrawal is delayed or incomplete because of prior long-term use. IAT preserves meaningful islet function in most patients and substantial islet function in >2/3 of patients with insulin-independence occurring in one-quarter of adults and half the children.
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影响因子：
6.2
作者：
Balamurugan, A. N.;Breite, Andrew G.;Hering, Bernhard J.
通讯作者：
Hering, Bernhard J.
影响因子：
12.6
作者：
Bellin, Melena D.;Freeman, Martin L.;Sutherland, David E. R.
通讯作者：
Sutherland, David E. R.
影响因子：
6.2
作者：
Clayton, HA;Davies, JE;Dennison, AR
通讯作者：
Dennison, AR
影响因子：
3.4
作者：
Bellin MD;Blondet JJ;Beilman GJ;Dunn TB;Balamurugan AN;Thomas W;Sutherland DE;Moran A
通讯作者：
Moran A
DOI：
10.1097/mpg.0b013e31815cbaf9
发表时间：
2008-07-01
影响因子：
2.9
作者：
Bellin, Melena D.;Carlson, Annelisa M.;Sutherland, David E. R.
通讯作者：
Sutherland, David E. R.