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Medline ® Abstract for Reference 48

of '全胰切除术'

48
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Long-term outcomes after total pancreatectomy and islet cell autotransplantation: is it a durable operation?
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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
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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.
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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.
PMID