著者

大橋 朋史 富丸 慶人 丸橋 繁 友國 晃 浅岡 忠史 和田 浩志 江口 英利 土岐 祐一郎 森 正樹 永野 浩昭

出版者

一般社団法人 日本消化器外科学会

雑誌

日本消化器外科学会雑誌 (ISSN:03869768)

巻号頁・発行日

vol.49, no.3, pp.185-191, 2016-03-01 (Released:2016-03-18)

参考文献数

12

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症例は44歳の女性で,24歳時にBudd-Chiari症候群と診断され,経過観察されていた.34歳時に肝硬変の進行のため,脳死肝移植登録(医学的緊急度:3点)を行った.その後,11年の移植待機後,44歳時に肝機能悪化に伴い医学的緊急度を3点から6点にランクアップし再登録した.その約1か月後に脳死ドナーが発生し,脳死肝移植術を施行しえた.手術から1年経過した現在,肝機能を含め全身状態良好で,外来経過観察中である.本症例では脳死肝移植を施行することが可能であったものの,欧米と比較して移植待機期間は極めて長いものであった.この長期待機期間は本邦における脳死ドナー不足によるものであり,脳死移植医療における現在の深刻な問題であると考えられた.

著者

富丸 慶人 後藤 邦仁 小林 省吾 永野 浩昭 森 正樹 土岐 祐一郎 江口 英利 伊藤 壽記 野口 洋文 宮下 和幸 川本 弘一 岩上 佳史 秋田 裕史 野田 剛広

出版者

一般社団法人 日本移植学会

雑誌

移植 (ISSN:05787947)

巻号頁・発行日

vol.54, no.4, pp.217-222, 2019

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<p>Total pancreatectomy with islet autotransplantation is an ideal surgical procedure used to relieve chronic pain derived from the pancreatitis, while insulin-dependent diabetes is inevitably induced after the surgery. Islet autotransplantation combined with a total pancreatectomy can reduce the risk of severe diabetes by preserving available islet cells. We experienced a case with hereditary pancreatitis, which is a rare inherited condition characterized by recurrent acute pancreatitis and/or chronic pancreatitis. The case was that of a female in her thirties who was introduced to our hospital due to treatment-refractory abdominal pain derived from repeated pancreatitis even after surgical treatments. At the introduction, the pain was uncontrollable even by opioid use, and oral intake was impossible due to increase of the pain after the intake. She was genetically diagnosed with hereditary pancreatitis. For relieving the pancreatitis-derived pain, total remnant pancreatectomy with islet autotransplantation was planned. After the pancreatectomy, islet cells were extracted from the excised remnant pancreas, and injected into the portal vein for liver autotransplantation. The pain was completely relieved for her after the surgery, suggesting improvement of her quality-of-life. A glucose tolerance test and glucagon loading test performed one month after the surgery showed C-peptide secretion as the blood glucose rose. However, the serum c-peptide level and SUIT index had been gradually decreased after the surgery, and she is now treated with insulin. The case suggested that total pancreatectomy with islet autotransplantation is useful for improvement of the patient's quality of life by controlling the pain in cases with hereditary pancreatitis.</p>