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Medline ® Abstract for Reference 48

of '全胰切除术'

Long-term outcomes after total pancreatectomy and islet cell autotransplantation: is it a durable operation?
Wilson GC, Sutton JM, Abbott DE, Smith MT, Lowy AM, Matthews JB, Rilo HL, Schmulewitz N, Salehi M, Choe K, Brunner J, Hanseman DJ, Sussman JJ, Edwards MJ, Ahmad SA
Ann Surg. 2014 Oct;260(4):659-65; discussion 665-7.
OBJECTIVE: Total pancreatectomy and islet cell autotransplantation (TPIAT) has been increasingly utilized for the management of chronic pancreatitis (CP) with early success. However, the long-term durability of this operation remains unclear.
METHODS: All patients undergoing TPIAT for the treatment of CP with 5-year or greater follow-up were identified for inclusion in this single-center observational study. End points included narcotic requirements, glycemic control, islet function, quality of life (QOL), and survival.
RESULTS: Between 2000 and 2013, 166 patients underwent TPIAT; 112 of these patients had 5-year follow-up data to analyze. All patients underwent successful IAT with a mean of 6027±595 islet equivalents per body weight.There was no perioperative mortality and actuarial survival at 5 years was 94.6%. The narcotic independence rate at 1 year was 55% and continued to improve to 73% at 5-year follow-up (P<0.05). The insulin independence rate declined over time (38% at 1 year vs 27% at more than 5 years), but insulin requirements remained similar (21.4 vs 24.3 units per day, P = 0.6). All patients achieved stable glycemic control with a median hemoglobin A1C (HgA1C) of 6.9% (range: 5.85%-8.3%). The short form 36-item QOL assessment of a subset of patients available for contact demonstrated continued improvements in all tested modules in patients with at least 5-year follow-up. Two patients developed diabetic complications requiring whole organ pancreas transplant for salvage.
CONCLUSIONS: This represents one of the largest series examining long-term outcomes after TPIAT. This operation produces durable pain relief and improvement in QOL parameters. Insulin independence rates decline over time, but most patients maintain stable glycemic control.
Departments of *Surgery†Gastroenterology‡Endocrinology§Radiology, University of Cincinnati Medical Center¶Department of Surgery, University of California San Diego School of Medicine‖Department of Surgery, University of Chicago Medical Center; and **Department of Surgery, University of Arizona Medical Center.