32例胰、肾同期联合移植的近期疗效  

Short-term follow-up of 32 simultaneous pancreas-kidney transplantation

作　　者：明长生[1] 甑忠广[1] 曾凡军[1] 陈知水[1] 张伟杰[1] 林正斌[1] 魏来[1] 宫念樵[1] 刘斌[1] 蒋继贫[1] 徐逸[1] 陈文伟[1] 陈忠华 

机构地区：[1]华中科技大学同济医学院附属同济医院器官移植研究所教育部/卫生部器官移植国家重点实验室,武汉430030

出　　处：《中华器官移植杂志》2006年第1期36-39,共4页Chinese Journal of Organ Transplantation

基　　金：教育部留学回国人员科研基金(No.1998679);教育部高校中青年骨干教师基金(教技司2000143)资助

摘　　要：目的报告32例胰、肾同期联合移植(SPK)的近期结果及经验。方法为合并尿毒症的27例1型糖尿病和5例2型糖尿病患者施行SPK,其中胰液膀胱引流(BD)术式2例,改进的胰液空肠引流(ED)术式30例。术后早期采用他克莫司、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32例手术均获得成功,术后随访2～12个月,1例术后9周死于肺部感染,死亡时肾功能正常,另1例术后6个月死于急性心肌梗死,死亡时移植胰、肾功能正常,其余患者目前仍存活;术后(12.7±8.1)d空腹血糖恢复正常,(8.3±4.5)d停用胰岛素,(8.4±7.8)d血肌酐恢复正常。术后发生手术相关并发症有出血、移植胰切口感染、上消化道出血、右股静脉血栓形成和淋巴漏;其它并发症有药物不良反应、肺部感染,采用BD术式者并发代谢性酸中毒和镜下血尿;4例发生移植肾急性排斥反应,均经活检证实。结论SPK治疗糖尿病并发尿毒症的近期疗效满意,ED术式更符合正常生理。Objective To summarize the short-term results of simultaneous pancreas-kidney transplantation （SPK） at a single-center in China. Methods SPK was performed in 32 consecutive patients from Jan. 2000 to July 2005. All patients had long-standing insulimdependent diabetes mellitus （IDDM） and subsequent renal failure. Bladder drainage （BD） of exocrine secretion was used in the first 2 cases and enteric drainage （ED） in last 30 patients. The patients were treated with quadruple therapy, which included antilymphocyte globulin （ALG） or anti-CD25 monoclonal antibody induction therapy, prednisone, tacrolimus and mycophenolat mofetil （MMF）. Results SPK was successfully applied to all cases. All patients have achieved excellent renal function and euglycemia, and no further insulin treatment was needed in 8. 3 ± 4.5 days posttransplant. The mean hospital stay was 51.4 ± 21.3 days. Two patients died due to lung cytomegalovirus infection and secondary sepsis 9 weeks and to acute myocardial infarct 6 months after operation, respectively. The death occurred with functioning grafts. Four biopsyproven renal rejection episodes occurred in 6 to 12 months postoperation. Main complications included wound infections in the side of pancreatic graft, peripancreatitis, and hemorrhage. Conclusion SPK is a effective treatment option for selected patients with type I diabetes mellitus and approaching end-stage renal disease. El） might be a more physiological and prior procedure than BD. The combination of tacrolimus and MMF can be used as a preferred, maintenance immunosuppressive in SPK.

关 键 词：胰腺 肾 移植 治疗结果 

分 类 号：R617[医药卫生—外科学]