Total pancreatectomy and islet cell autotransplantation as a means of treating patients with genetically linked pancreatitis
Total pancreatectomy and islet cell autotransplantation as a means of treating patients with genetically linked pancreatitis
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DOI：
10.1016/j.surg.2010.07.043
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发表时间：
2010-10-01
期刊：
影响因子：
3.8
通讯作者：
Ahmad, Syed A.
中科院分区：
文献类型：
--
作者：
Sutton, Jeffrey M.;Schmulewitz, Nathan;Ahmad, Syed A.
背景对于慢性重症胰腺炎患者，全胰切除联合自体胰岛细胞移植（IAT）可减轻患者痛苦，避免糖尿病并发症。一些基因突变，特别是PRSS 1，CFTR和SPINK 1，与慢性胰腺炎相关。很少有报道关注这种手术对这部分患者的益处。2000年2月至2009年7月，118例患者接受全胰腺切除术和IAT治疗慢性胰腺炎。然后选择具有已知基因突变的患者进行进一步分析。在188例患者中，16例（13.6%）患者被确定为具有基因突变，包括CFTR（n = 10）、PRSS 1（n = 4）和SPINK 1（n = 2）突变。患者平均年龄为31.4岁（范围：15-59岁），男女比例相等（50：50）。术前，患者需要平均185 - 60吗啡当量（MEQ）（中位数，123 MEQ）的术前疼痛控制。所有患者术前均未使用胰岛素。IAT切除术后，患者出院时平均每天使用22.4个单位的胰岛素，6例（38%）患者出院时需要少于15个单位的胰岛素。在平均随访22个月时，平均胰岛素需求量降至15 U/d（P = 0.0172）。共有7例（44%）患者每天需要15个或更少单位，4例（25%）患者完全不依赖胰岛素。最近一次随访时，平均每日麻醉剂使用量下降至70 MEQ（中位数，0），其中10名（63%）患者目前不依赖麻醉剂。对36项简明健康调查表和麦吉尔疼痛问卷的分析表明，生活质量参数和疼痛评估有显着改善。在患有遗传性慢性胰腺炎的患者中，胰腺切除术联合IAT应被视为早期治疗选择，以减少慢性腹痛，同时保留内源性内分泌功能。（Surgery 2010;148：676-86.）
Background. For patients with severe chronic pancreatitis, total or completion pancreatectomy with islet cell autotransplantation (IAT) can alleviate pain and avoid the complications of diabetes. Several genetic mutations, specifically, PRSS1, CFTR, and SPINK1, are associated with chronic pancreatitis. Few reports have focused on the benefit of this operation for this subset of patients.Methods. Between February 2000 and July 2009, 118 patients were treated with total pancreatectomy and IAT for chronic pancreatitis. Patients with known genetic mutations were then selected for further analysis.Results. Of the 188 patients, 16 (13.6%) patients were identified as having genetic mutations, including CFTR (n = 10), PRSS1 (n = 4), and SPINK1 (n = 2) mutations. Mean patient age was 31.4 years (range, 15-59) with an equal male-to-female ratio (50:50). Preoperatively, patients required an average of 185 60 morphine equivalents (MEQ) (median, 123 MEQ) for preoperative pain control. No patients were taking insulin before operation. After resection with IAT patients were discharged from the hospital with a daily average of 22 4 units of insulin with 6 (38%) patients requiring fewer than 15 units of insulin at the time of discharge. At a mean follow-up of 22 months, mean insulin requirements decreased to 15 U/d (P = .0172). A total of 7 (44%) patients required 15 or fewer units daily, and 4 (25%) patients were completely insulin-independent. Average daily narcotic usage at most recent follow-up decreased to 70 MEQ (median, 0) with 10 (63%) patients currently narcotic-independent. Analyses of the 36-item short-form health survey and the McGill Pain Questionnaire demonstrated a significant improvement in quality-of-life parameters and pain assessment.Conclusion. In patients who suffer from genetically linked chronic pancreatitis, pancreatic resection with IAT should be considered as an early therapeutic option to decrease chronic abdominal pain while preserving endogenous endocrine function. (Surgery 2010;148:676-86.)