腹腔镜保留脾脏远端胰腺切除联合自体胰岛移植治疗导管内乳头状黏液瘤：病例报告及文献分析

Laparoscopic spleen-preserving distal pancreatectomy combined with autologous islet transplantation for intraductal papillary mucinous neoplasms: a case report and literature review

摘要:

背景与目的 腹腔镜保留脾脏远端胰腺切除术（LSPDP）是胰腺体尾部导管内乳头状黏液瘤（IPMN）的常用术式，但可能因正常胰腺组织丢失增加术后3c型糖尿病（T3cDM）风险。自体胰岛移植（AIT）可用于保护内分泌功能，但其在IPMN患者中的应用仍存在争议。本研究旨在探讨LSPDP联合AIT治疗IPMN的安全性与可行性。方法 报告1例56岁女性IPMN患者行LSPDP联合AIT。切除胰腺组织41.6 g，经GMP实验室分离获得胰岛1 139 IEQ/kg，纯度20%，存活率97%。在腹腔镜及术中超声引导下，经门静脉输注胰岛。术后给予抗凝、营养支持及严格血糖控制。结果 术后恢复顺利，未发生出血、感染、门静脉血栓、胰瘘或肿瘤复发。随访1年，患者空腹及餐后血糖、C肽水平均处于正常范围，未发生T3cDM。影像学复查未见复发征象，内分泌功能维持良好。结论 在严格筛选及确保肿瘤学安全的前提下，LSPDP联合AIT可在切除IPMN的同时实现胰腺内分泌功能的短期保留，具有良好的安全性与可行性。但其长期代谢获益及肿瘤学结局仍需进一步随访验证。

Abstract:

Background and Aims Laparoscopic spleen-preserving distal pancreatectomy (LSPDP) is a standard procedure for intraductal papillary mucinous neoplasms (IPMN) of the pancreatic body and tail, but it may increase the risk of postoperative type 3c diabetes mellitus (T3cDM) due to loss of normal pancreatic tissue. Autologous islet transplantation (AIT) may preserve endocrine function; however, its application in IPMN remains controversial. This study aimed to evaluate the safety and feasibility of LSPDP combined with AIT.Methods A 56-year-old woman with IPMN underwent LSPDP combined with AIT. A total of 41.6 g of pancreatic tissue was resected, and islets were isolated in a GMP facility, yielding 1 139 IEQ/kg with 20% purity and 97% viability. Islets were infused into the portal vein under laparoscopic and intraoperative ultrasound guidance. Postoperative management included anticoagulation, nutritional support, and strict glycemic control.Results The postoperative course was uneventful, with no complications such as bleeding, infection, portal vein thrombosis, pancreatic fistula, or tumor recurrence. During 1-year follow-up, fasting and postprandial glucose levels and C-peptide remained within normal ranges, and no T3cDM occurred. Imaging showed no evidence of recurrence, and endocrine function was well preserved.Conclusion Under strict patient selection and oncological safety, LSPDP combined with AIT may achieve tumor resection while preserving endocrine function in IPMN patients, demonstrating favorable short-term safety and feasibility. Long-term metabolic and oncological outcomes require further validation.