膀胱引流式胰肾联合移植术后严重代谢性酸中毒的外科治疗  

Conversion from bladder to ileal drainage for the treatment of metabolic acidosis following simultaneous pancreas and kidney transplantation (a case report)

作　　者：周高标[1] 洪泉[1] 汪泽厚[1] 孙斌[1] 姚志勇[1] 石孝民[1] 李贤初[1] 

机构地区：[1]空军总医院泌尿外科,北京100036

出　　处：《中华泌尿外科杂志》2006年第12期825-826,共2页Chinese Journal of Urology

摘　　要：目的探讨膀胱引流式胰肾联合移植长期存活受者代谢性酸中毒的治疗方法。方法1例女性45岁糖尿病肾病、尿毒症患者膀胱引流式胰肾联合移植术后3年并发严重代谢性酸中毒,二次手术改为回肠引流。绕移植胰腺十二指肠膀胱吻合口切除已游离的带膀胱壁吻合口,于距回盲部40 cm处回肠与移植胰腺十二指肠段行侧侧吻合,吻合口长约5 cm,距吻合口15 cm处再行回肠襻侧侧吻合。结果患者术后恢复好,服用常规免疫抑制剂,住院30 d。随访4年,患者血气分析正常,肾功能、血糖波动在正常范围。结论膀胱引流式胰肾联合移植术后严重代谢性酸中毒患者改用回肠引流是一种有效、安全的治疗方法。Objective To investigate the therapeutic method of metabolic acidosis in long-term survival patients undergoing simultaneous pancreas and kidney transplantation. Methods A 45-year-old female patient, who had undergone simultaneous pancreas and kidney transplantation （due to diabetic nephropathy and uremia） with bladder drainage 2 years before,developed severe metabolic acidosis,and thus underwent surgical conversion from bladder to ileal drainage. The procedure was as follows. The stoma of duodeuocystostomy was isolated and resected. The site of cystostomy was closed in two layers. The graft duodenum was then anastomosed to a loop of the recipient＇s ileum, which was proximal 40 cm from the ileocecum in a side-to-side manner. Results The metabolic acidosis resolved postoperatively. The patient received conventional immunosuppressants. The hospital stay was 30 d. Follow-up of 4 years showed normal pancreas and kidney functions. Conclusions Conversion from bladder to ileal drainage is safe and effective for metabolic acidosis related to the exocrine secretions of bladder drained pancreas graft in simultaneous pancreas and kidney transplant recipients.

关 键 词：胰腺 肾 器官移植 酸中毒 

分 类 号：R699[医药卫生—泌尿科学]