经门静脉及肠道引流式一期胰肾联合移植六例报告  

Simultaneous kidney-pancreatic transplantation with portal venous and enteric drainage:a report of 6 cases

作　　者：钟林[1] 彭志海[1] 裘正军[1] 夏强[1] 陈国庆[1] 祝哲诚[1] 徐军明[1] 刘俊[1] 王书云[1] 

机构地区：[1]上海交通大学附属第一人民医院器官移植中心,200080

出　　处：《中华普通外科杂志》2005年第7期394-396,共3页Chinese Journal of General Surgery

基　　金：上海市科学发展基金重大项目(024119002);上海市西部开发科技合作项目(034958033)

摘　　要：目的介绍6例门静脉肠道引流胰肾联合移植术及其疗效.方法对6例胰岛素依赖性型糖尿病合并尿毒症患者施行了同期门静脉肠道引流胰肾联合移植术,即带腹腔动脉和肠系膜上动脉开口的Carrel袖片与髂外动脉行端侧吻合,门静脉与受体肠系膜上静脉行端侧吻合,移植物十二指肠与受体空肠行侧侧双层吻合.术后早期采用肾上腺皮质激素+霉酚酸酯+他克莫司+巴利昔单抗四联诱导治疗.结果6例胰肾联合移植手术均获成功,4例存活至今,2例在围手术期死亡.4例存活者术后3 d空腹血糖恢复正常;停用胰岛素后,肾功能3～5 d恢复正常;血淀粉酶和血清C肽水平2周后均在正常范围.随访4～34个月,移植胰和移植肾功能正常.2例死亡的原因是胰漏感染和FK506药物中毒.结论门静脉肠道引流方法更符合生理,无远期并发症,是很有前途的胰腺移植手术方式.Objective To evaluate clinical effect of simultaneous kidney-pancreatic transplantation （SKPT） with portal venous and enteric drainage. Method Between June 2001 and June 2004, sixinsulin-dependent diabetes mellitus（ IDDM ） and renal failure patients underwent this procedure. The venous drainage of the graft was established between donor＇s portal vein and recipient＇s superior mesenteric vein. The exocrine secretion was drained into proximal jejunum via side-to-side anastomosis between donor＇s duodenum and recipient＇s proximal jejunum. Steroids, mycophenolate mofetil, tacrolimus and Zenapax were used as immunosuppressants. Results Procedures were successful in all 6 cases. Excellent renal function and euglycemia were achieved in 4 cases. Follow-up of 4-34 months on the 4 survivers found excellent kidney-pancreatic function without any rejection episode. Two patients died perioperatively due to sepsis secondary to pancreatic leakage and drug toxicosis of excessive FKS06. Conclusion Our preliminary experience suggests that simultaneous pancreas-kidney transplantation with enteric and portal drainage is reliable procedure for the treatment of IDDM with renal failure.

关 键 词：门静脉 肠道引流式 胰肾联合移植 胰岛素依赖型 糖尿病 

分 类 号：R617[医药卫生—外科学]