摘要
目的总结和探讨胰肾联合移植(SPK)手术的手术适应证、术式选择、免疫抑制方案制定及并发症防治的经验。方法回顾分析2002年至2018年145例SPK的临床资料,按不同阶段分为A组(2002—2010年)15例、B组(2011—2014年)46例及C组(2015—2018年)84例,比较三组受者及移植物存活、手术方式、免疫抑制剂方案、并发症发生情况,分析移植物功能丧失的危险因素。结果三组受者及移植物术后1、3、5年存活率(C组为术后1、3年存活率)均在75%以上,B组和C组受者存活率高于A组(P<0.001),B组移植胰腺存活率最低,C组最高(P=0.004)。C组更倾向采用胰肾同侧移植、胰腺静脉体循环回流和肠外分泌引流手术方式(SE-ED术式)。B组术后移植物血管血栓形成发生率最高(10.9%);A组肠梗阻发生率最高(35.7%)。采用阿加曲班抗凝方案的移植胰腺功能丧失风险是无阿加曲班抗凝方案的0.28倍(OR为0.28,95%可信区间0.09~0.86);1型糖尿病受者SPK术后移植肾功能丧失风险是2型糖尿病受者的4.08倍(OR为4.08,95%可信区间为1.37~12.15)。结论胰肾联合移植是治疗糖尿病合并终末期肾病的最有效手段;严格标准选择合适的2型糖尿病合并终末期肾病患者进行SPK;围手术期的管理及并发症的防治对SPK受者及移植物存活的至关重要。
Objective To explore the surgical indications for pancreas-kidney surgery and summarize the experiences of, selecting surgical approaches, formulating immunosuppressive regimens and preventing complications. Methods A total of 145 donor simultaneous pancreas-kidney transplants in uremic patients with T1DM/T2DM between 2002 and 2018 were retrospectively analyzed. Based upon surgical approaches and immunosuppressive agents, they were divided into three eras of 2002-2010, 2011-2014 and 2015-2018 respectively. Patient profiles, survival outcomes of patient and graft, surgical techniques, immunosuppressive agents and incidence of common complications were compared among different groups. Results The overall 1/3/5-year patient and graft survival rates of three groups were above 75% and the survival rates of group Ⅰ were inferior to those of groups Ⅱ and Ⅲ(P<0.001). The overall 1/3/5-year pancreas graft survival rates were the highest in group Ⅲ and the lowest in group Ⅱ(P=0.004). In the 2015-2018 group, ipsilateral pancreas-kidney transplantation and SE-ED surgery were more preferred. Regarding the incidence of complications, graft thrombosis frequently occurred from 2011 to 2014 and intestinal obstruction was more common from 2002 to 2010. For univariable analysis of graft loss, anticoagulation programme with argatroban monohydrate were 0.28 times likely to lose pancreas graft (OR=0.28, 95%CI: 0.09-0.86) and T1DM patients were 4 times likely to have kidney graft loss (OR=4.08, 95%CI: 1.37-12.15). Conclusions SPK is an effective treatment for uremic diabetics. Effective perioperative management and preventing complications are crucial for prolonging patient and graft survivals.
作者
付迎欣
王辉
冯钢
宋文利
莫春柏
史晓峰
王振
曹玉
赵杰
沈中阳
Fu Yingxin;Wang Hui;Feng Gang;Song Wenli;Mo Chunbai;Shi Xiaofeng;Wang Zhen;Cao Yu;Zhao Jie;Shen Zhongyang(First CentralMunicipal Hospital, Tianjin 300192, China)
出处
《中华器官移植杂志》
CAS
北大核心
2019年第5期260-265,共6页
Chinese Journal of Organ Transplantation
关键词
胰肾联合移植
手术适应证
手术方式
移植物功能丧失
危险因素
并发症
防治
Simultaneous pancreas-kidney transplantation
Operative indication
Surgical techniques
Graft loss
Risk factor
Complication
Prevention
