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Total pancreatectomy with islet cell transplantation vs intrathecal narcotic pump infusion for pain control in chronic pancreatitis

引用

World Journal of Gastroenterology 2016年第16期22卷 4160-4167页

作者： Mohamad Mokadem Lama Noureddine Thomas Howard Lee Mc Henry Stuart Sherman Evan L Fogel James L Watkins Glen A Lehman Division of Gastroenterology and Hepatology Roy J. and Lucille A. Carver College of Medicine University of Iowa Iowa IA 52242 United States Division of Nephrology and Hypertension Roy J. and Lucille A. Carver College of Medicine University of Iowa Iowa IA 52242 United States Community Health Network Indianapolis IN 46219 United States Division of Gastroenterology and Hepatology Indiana University Medical Center Indianapolis IN 46202 United States

AIM: To evaluate pain control in chronic pancreatitis patients who underwent total pancreatectomy with islet cell transplantation or intrathecal narcotic pump ***: We recognized 13 patients who underwent intrathecal narcotic pump(ITNP) infusion and 57 patients who underwent total pancreatectomy with autologous islet cell transplantation(TP + ICT) for chronic pancreatitis(CP) pain control between 1998 and 2008 at Indiana University Hospital. All patients had already failed multiple other modalities for pain control and the decision to proceed with either intervention was made at the discretion of the patients and their treating physicians. All patients were evaluated retrospectively using a questionnaire inquiring about their pain control(using a 0-10 pain scale), daily narcotic dose usage, and hospital admission days for pain control before each intervention and during their last follow-up. RESULTS: All 13 ITNP patients and 30 available TP + ICT patients were evaluated. The mean age was approximately 40 years in both groups. The median duration of pain before intervention was 6 years and 7 years in the ITNP and TP + ICT groups, respectively. The median pain score dropped from 8 to 2.5(on a scale of 0-10) in both groups on their last follow up. The median daily dose of narcotics also decreased from 393 mg equivalent of morphine sulfate to 8 mg in the ITNP group and from 300 mg to 40 mg in the TP + ICT group. No patient had diabetes mellitus(DM) before either procedure whereas 85% of those who underwent pancreatectomy were insulin dependent on their last evaluation despite ICT. CONCLUSION: ITNP and TP + ICT are comparable for pain control in patients with CP however with high incidence of DM among those who underwent TP + ICT. Prospective comparative studies and longer follow up are needed to better define treatment outcomes.

关键词： Chronic pancreatitis Intractable pain Total pancreatectomy Islet cell transplantation intrathecal narcotic pump infusion

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