经皮经肝穿刺门静脉胰岛细胞移植改良手术的安全性与疗效  

Safety and efficacy of modified percutaneous transhepatic portal vein islet cell transplantation

作　　者：孟小茜 廖华强 董伟华 季峻松 郭猛 傅志仁 殷浩 Meng Xiaoqian;Liao Huaqiang;Dong Weihua;Ji Junsong;Guo Meng;Fu Zhiren;Yin Hao(Department of Interventional Diagnosis and Treatment,Shanghai 200041,China;Department of Organ Transplantation,Shanghai Changzheng Hospital Affiliated to Naval Medical University,Shanghai 200041,China)

机构地区：[1]海军军医大学附属上海长征医院介入诊疗科,上海200041 [2]海军军医大学附属上海长征医院器官移植科,上海200041

出　　处：《中华肝脏外科手术学电子杂志》2022年第2期144-148,共5页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：国家自然科学基金面上项目(82070798,81870530);中国器官移植发展基金会“菁英计划”(2019JYJH10);上海市科学技术委员会/卫生健康委/申康医院发展中心/人力资源和社会保障局科研项目(19QA1408600,2018YQ53,SHDC12018X14,2020069)。

摘　　要：目的探讨经皮经肝穿刺门静脉胰岛细胞移植改良手术的安全性与疗效。方法回顾性分析2016年12月至2020年6月海军军医大学附属上海长征医院行经皮经肝穿刺门静脉胰岛细胞移植术的46例患者临床资料。其中男34例,女12例;年龄13~74岁,中位年龄49岁。患者均签署知情同意书,符合医学伦理学规定。根据手术方法不同,患者分为常规介入手术组(常规组,25例次)和改良介入手术组(改良组,27例次)。常规组采用4F单弯动脉造影导管胰岛细胞滴注,实时压力监测,并采用钢圈+明胶海绵颗粒封堵穿刺道;改良组采用手动裁剪内芯的PTCD导管滴注,间断压力监测,并采用明胶海绵颗粒封堵穿刺道。两组手术时间、门静脉压力等比较采用t检验,率的比较采用χ^(2)检验。结果46例患者共52例次胰岛细胞移植手术均顺利完成,手术成功率100%。其中常规组二次移植2例,改良组4例。常规组和改良组手术时间分别为(124±14)、(110±17)min,差异无统计学意义(t=1.35,P>0.05)。常规组术前、术后门静脉压力分别为(13±4)、(12±3)mmHg(1 mmHg=0.133 kPa),改良组分别为(16±3)、(14±5)mmHg,手术前、后门静脉压力比较差异均无统计学意义(t=0.34,0.87;P>0.05)。常规组术后胸腔出血1例,改良组肝内血肿1例,均经保守治疗后出血停止,出血发生率分别为4%(1/25)、4%(1/27),差异无统计学意义(χ^(2)=0.45,P>0.05)。常规组和改良组半年首次移植患者的胰岛素脱离率分别为60%(15/25)、66%(18/27),差异无统计学意义(χ^(2)=5.32,P>0.05)。常规组和改良组空腹C肽增量分别为(0.22±0.07)、(0.19±0.06)nmol/L,餐后2小时C肽增量分别为(0.67±0.20)、(0.53±0.17)nmol/L,差异无统计学意义(t=1.362,1.722;P>0.05)。结论与常规手术相比,经皮经肝穿刺门静脉胰岛细胞移植改良手术同样安全、有效,且有减少肝内钢圈使用,后期影像学检查无伪影等优势。Objective To evaluate the safety and efficacy of modified percutaneous transhepatic portal vein islet cell transplantation.Methods Clinical data of 46 patients undergoing percutaneous transhepatic portal vein islet cell transplantation in Shanghai Changzheng Hospital Affiliated to Naval Medical University from December 2016 to June 2020 were retrospectively analyzed.Among them,34 patients were male and 12 female,aged from 13 to 74 years,with a median age of 49 years.The informed consents of all patients were obtained and the local ethical committee approval was received.According to different surgical methods,all patients were divided into the conventional intervention group(conventional group,n=25)and modified intervention group(modified group,n=27).In the conventional group,infusion of islet cells was performed with F single-curved arteriographic catheter under real-time pressure monitoring,and the puncture channel was blocked up with steel ring and gelfoam particles.In the modified group,PTCD catheter infusion with manually-cutted inner core was performed under intermittent pressure monitoring,and the puncture channel was blocked up with gelfoam particles.The operation time and portal pressure between two groups were compared by using t test and the rate comparison was analyzed by Chi-square test.Results 46 patients successfully completed 52 times of islet cell transplantation,with a success rate of 100%.Among them,2 recipients received twice transplantation in the conventional group and 4 in the modified group.The operation time in the conventional and modified group was(124±14)and(110±17)min,respectively,where no significant difference was observed(t=1.35,P>0.05).In the conventional group,the portal vein pressure before and after transplantation were(13±4)and(12±3)mmHg(1 mmHg=0.133 kPa),and(16±3)and(14±5)mmHg in the modified group,where no significant difference was observed between portal vein pressures before and after operation(t=0.34,0.87;P>0.05).1 case developed postoperative thoracic hemorrhage i

关 键 词：胰岛移植 门静脉 穿刺术 治疗结果 

分 类 号：R47[医药卫生—护理学]