全胰腺切除胰岛自体移植治疗慢性或复发性急性胰腺炎的研究进展

Research progress of total pancreatectomy with islet autotransplantation for chronic pancreatitis or recurrent acute pancreatitis

全胰腺切除胰岛自体移植(TPIAT)是一种复杂的外科手术,用于治疗复发性急性胰腺炎(RAP)和慢性胰腺炎,能够消除胰腺炎发生胰腺癌的风险,同时降低严重糖尿病的威胁。美国和国际上越来越多的医学中心正在开展TPIAT。多家医学中心的研究强调了TPIAT对RAP和慢性胰腺炎的益处和挑战。然而,其缺乏关于适应证、禁忌证、评估、治疗时机和随访的明确指南。笔者回顾TPIAT的历史,探讨TPIAT的现状,包括治疗适应证、术前评估、手术方式、胰岛分离、胰岛组织门静脉内输注、术后管理以及单中心开展TPIAT的经验。笔者认为:开展大宗病例的多中心研究对于优化TPIAT至关重要。

Total pancreatectomy with islet autotransplantation,(TPIAT)is a complex surgical procedure for recurrent acute pancreatitis(RAP)and chronic pancreatitis,which can eliminate the risk of pancreatitis for pancreatic cancer and reduce the threat of severe diabetes mellitus.An increasing number of centers,here in the United States and internationally,are performing TPIAT and studies emerging from multiple centers highlight the benefits and persistent challenges of TPIAT for RAP and chronic pancreatitis.However,clear guidance on indications,contraindications,evaluation,timing of treatment and follow‐up is lacking.The author reviews the history of TPIAT,and discusses the current state of TPIAT including indications of treatment,preoperative evaluations,surgical method,islet isolation and portal vein infusion,and postoperative management and a single center′s experience in TPIAT.A multiple center study with large numbers of patients will be critical to optimizing the successful application of this procedure.