胰肾联合移植后长期存活患者的临床观察  

Clinical observation on long-term survival in patients after simultaneous kidney-pancreas transplantation(report of 6 cases)

作　　者：于立新[1] 余玉明[1] 邓文锋[1] 徐健[1] 付绍杰[1] 杜传福[1] 王亦斌[1] 叶桂荣[1] 刘小友[1] 苗芸[1] 李川江[1] 叶俊生[1] 

机构地区：[1]南方医科大学南方医院器官移植科,广州510515

出　　处：《中华泌尿外科杂志》2006年第7期458-461,共4页Chinese Journal of Urology

基　　金：全军医学科学技术研究"十五"计划基金重点课题项目(01Z049);广东省科技攻关项目(2KM05101S)

摘　　要：目的总结胰肾联合移植患者长期存活的临床经验。方法2001年10月至2004年7月行胰肾联合移植术6例,均采用供者十二指肠与受者空肠侧侧吻合的改良式胰液肠腔引流术式,术前口服吗替麦考酚酯500mg,他克莫司2mg,术中用甲泼尼龙(MP)1.0g。术后2例用2剂抗白细胞介素2受体单克隆抗体,4例用抗胸腺细胞球蛋白诱导治疗,术后1～3d分别用MP冲击治疗,术后第2天开始应用他克莫司、吗替麦考酚酯、泼尼松三联免疫抑制治疗方案维持治疗。每日用那屈肝素钙(速避凝)或前列地尔等抗凝药物防止移植胰腺血栓形成。应用生长抑素预防移植胰胰腺炎。术后3～5d肾功能恢复顺利时加用更昔洛韦预防巨细胞病毒感染。术后随访15～49个月。结果6例手术均获成功。术后血糖6～16mmol/L,应用小剂量胰岛素5～10d后停用,6例患者血糖均维持在正常范围。1例术后第7天出现他克莫司浓度过高所致肾中毒,经血液透析治疗3次,他克莫司减量后,肾功能恢复正常。3例患者分别于术后第14、20、22天并发消化道出血,经对症治疗后出血停止。术后早期未发生胰瘘、肠瘘和血栓形成等并发症。6例均存活,存活4年以上者1例,3年以上者3例,2年和1年以上者各1例。胰腺功能良好,血糖正常。5例血肌酐(Scr)正常；1例Scr＞400μmol/L。结论胰肾联合移植是治疗I型糖尿病合并终末期肾病的有效方法,改良式胰-十二指肠及肾一期联合移植术手术操作相对简单,更符合生理,术后并发症少。供器官质量、组织配型、胰液引流方式、围手术期合理用药和术后远期感染是影响患者术后长期存活的重要因素。Objective To summarize the experience of long-term survival in patients after simultaneous kidney-pancreas transplantation （SKPT） with modified enteric drainage （ED）. Methods From October 2001 to July 2004,6 patients with end-stage renal disease due to Type 1 diabetes underwent SKPT with modified ED,ie, side-to-side anastomosis between the duodenum of donors and jejunum of recipients. The medication regimen included：mycophenolic＇acid 500 mg and tacrolimus 2 mg before operation; methylprednisolone （MP） 1.0 during operation; and 2-dose anti-IL-2 receptor monoclonal antibody （2 cases） or antihuman thymocyte globulin （ATG） （4 cases） for immune induction therapy;MP was used on the first 3 d after transplantation,triple immunosuppressive therapy （ tacrolimus, mycophenollc acid and prednisone） was used on the second d after transplantation. Anticoagulants such as low molecular heparin or alprostadil were used for 7 - 10 d to prevent thrombosis in pancreas graft. Somatostatin was used as prophylaxis for graft pancreatitis. Ganciclovir was used to prevent cytomegalovirus infection when renal graft gradually recovered 3 to 5 d after transplantation. The follow-up was from 1 year and 3 months to 4 years and 1 month. Results Transplantation was successful in all 6 cases. The blood sugar levels were 6 - 16 mmol/L. Low-dose insulin was used for 5 - 10 d,then the blood sugar levels returned to normal range. One of 6 patients experienced nephrotoxicity because of high tacrolimus blood concentration at 7 d after operation;after 3 dialyses and reduction of tacrolimus dose,the renal allograft regained normal function. Three cases experienced alimentary tract hemorrhage at 14,20 and 22 d, respectively, after operation;the bleeding was stopped after treatment. There were no complications such as pancreatic fistula, intestinal fistula and thrombosis early after operation. All the patients are now alive, specifically, 1 survived over 4 years,3 over 3 years, 1 over 2 years,and 1 over 1 year. All had norma

关 键 词：胰腺移植 十二指肠 肾移植 预后 

分 类 号：R699[医药卫生—泌尿科学] R657.5[医药卫生—外科学]