摘要
目的报道改良胰液空肠引流式胰肾联合移植的外科技术和其治疗糖尿病合并尿毒症的近期效果。方法 2000年6月至2006年8月,共有38例糖尿病合并尿毒症患者在华中科技大学同济医学院附属同济医院接受胰肾联合移植,移植胰腺的外分泌液用空肠内引流,不作 Roux-en-Y吻合。移植胰腺及肾脏的平均冷缺血时间分别为(10±2.0)h 和(7±2.0)h。除1例外,术后早期均采用他克莫司、霉酚酸酯及皮质激素预防排斥反应,同时以抗淋巴细胞球蛋白或抗 CD25单克隆抗体诱导治疗。结果受者、移植肾脏和胰腺的6个月存活率均为97.4%,平均停用胰岛素时间为(7±6.9)d,空腹血糖恢复正常的平均时间为(14±9.1)d。术后3周口服糖耐量试验、胰岛素和 C 肽释放试验显示移植胰腺功能完全正常。血淀粉酶恢复正常的平均时间为(10±7.7)d。肾功能延迟恢复8例,其血肌酐恢复正常的平均时间为(53±20.0)d;其余30例血肌酐恢复正常的平均时间为(8±7.4)d。术后主要外科并发症为移植胰腺伤口感染、胰十二指肠-空肠吻合口出血和移植肾脏周围出血,3例(7.9%)因并发症再次手术,未发生与胰液引流术式相关的并发症如胰漏、肠漏、腹腔脓肿及肠梗阻等。结论胰肾联合移植是治疗1型和部分2型糖尿病合并尿毒症的有效方法;改进的胰液空肠引流术式(不作 Roux-en-Y 吻合)有助于降低胰液空肠引流术式的术后早期并发症发生率,提高受者和移植物的存活率。
[Abstract] Objective To report the modified technique and the short-term results of simultaneous pancreas-kidney transplantation（SPK） with the enteric drainage（ED） of exocrine secretions. Methods From June 2000 to August 2006, thirty-eight patients with diabetes complicated with uremia underwent SPK. The pancreas graft was placed intraporitoneally with exocrine secretions drained into the proximal jejunum without Roux-en-Y procedure. The mean eold isehemie times of paneread and kidney were （10 ＋2. 0） h and （7 ＋ 2. 0） h, respectively. Quadruple immunosuppressive therapy with antilymphocyte globulin or anti-CD25 monoclonal antibody, tacrolimus, mycophenolate mofetil and steroids was adopted except one patient. Results The 6-month survival rates of patients and grafts were both 97.4% after transplantation. All patients achieved insulin-free euglyeemia at （7 ＋ 6.9） d postoperative except one. For preoperative patients, mean fasting insulin and C-poptide values were （9 ＋ 8. 1 ） mU/L and （6 ＋ 4. 5） mU/L. After operation, fasting insulin and C-peptide values of patients were （ 12 ~5. 8） mU/L and （6 ＋4. 7） mU/L,respoctively,whieh peaked to an insulin level of （57 ＋ 43.0 ） mU/L and a C-peptide level of （ 11 ＋ 6. 8 ） mU/L with stimulation. There were eight eases of delayed renal graft function. All other patients achieved immediate renal graft function. No graft losses occurred due to leakage or imra-abdominal infection. The most common surgieal eomplieations were wound infection （ n = 12）, enterie anastomostie hemorrage （ n = 5 ） and porirenal hemorrage （ n = 2） . Three patients （ 7.9% ） had been reoporated for the reasons of intra-abdominal hemorrhage and porirenal hemorrhage. Conclusions SPK is an effective treatment option for selected patients with diabetes mellitus and approaching end-stage renal disease. Enteric exocrine drainage hy direct side-to-side anastomosis （withoul Roux-en-Y） seems to be a simple and reliable technique.
出处
《中华外科杂志》
CAS
CSCD
北大核心
2007年第5期326-330,共5页
Chinese Journal of Surgery
关键词
糖尿病
胰腺移植
肠引流
膀胱引流
Diabetes mellitus
Pancreas transplantation
Enteric drainage
Bladder draittage
