改良胰液空肠引流式胰肾同期联合移植35例报告  

Simultaneous pancreas-kidney transplantation with modified enteric drainage of the exocrine pancreatic secretions: report of 35 cases

作　　者：明长生[1] 曾凡军[1] 张伟杰[1] 陈知水[1] 林正斌[1] 宫念樵[1] 魏来[1] 刘斌[1] 蒋继贫[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,武汉430030

出　　处：《中华普通外科杂志》2006年第12期841-844,共4页Chinese Journal of General Surgery

摘　　要：目的报告应用改良胰液空肠引流式胰、十二指肠及肾同期联合移植(SPK)的外科技术治疗35例胰岛素依赖型糖尿病并发尿毒症的近期效果。方法2000年6月-2006年1月,35例胰岛素依赖的糖尿病合并尿毒症患者接受SPK,移植胰的外分泌采用空肠内引流,不作Roux-en-Y型吻合。移植肾平均冷缺血时间为(6．92±2．17)h,移植胰平均冷缺血时间为(9．65±2．02)h。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。结果围手术期患者存活率达97．1％(34／35),存活病例全部停用胰岛素,平均停用胰岛素时间为(8．3±4．5)d,空腹血糖恢复正常时间为(13．4±8．9)d。术后3周口服糖耐量试验、胰岛素和C肽释放试验显示移植胰功能完全正常。血淀粉酶恢复正常时间平均为(9．3±7．0)d。肾功能延迟恢复(DGF)5例,血肌酐恢复正常时间平均为(58．2±16．8)d,其余30例血肌酐恢复正常时间平均为(7．7±5．4)d。术后主要外科并发症为移植胰伤口感染、胰十二指肠-空肠出血和移植肾周围出血。3例(8．6％)因并发症再次手术,未发生与胰液引流术式相关的并发症如胰漏、肠漏、腹腔脓肿及肠梗阻等。结论SPK是治疗1型和部分2型糖尿病并发尿毒症的有效方法;改进的胰液空肠引流术式(不作Roux-en-Y吻合)有助于降低胰液空肠引流术式的术后早期并发症发生率。Objective To report the modified technique and the short-term results of simultaneous pancreaticoduodenum-kidney transplantation （SPK） with the enteric drainage （ED） of exocrine secretions. Method Between June 2000 and Jan 2006, thirty-five patients with diabetes and uremia underwent SPK. The pancreas graft is placed intraperitoneally with its exocrine secretions drained into the proximal jejunum without Roux-en-Y procedure. The mean cold ischemic times of kidney was 6. 92 ± 2. 17 hours and that of pancreas, 9. 65 ± 2. 02 hours. Quadruple immunosuppressive therapy with antilymphocyte globulin or anti- CD25 monoclonal antibody （Zonapax）, tacrolimus, mycophenolate mofetil and steroids was adopted. Results Postoperative patient and graft survival rates were 97.3%. All patients achieved insulin-free euglycemia at 8. 3 ± 4. 5 days postoperatively. Preoperative patient＇ s mean fasting insulin and C-peptide values were 7.45 ± 7.35 mU/L and 5.68 ± 4. 66 mU/L. After operation, patients had fasting insulin and C-peptide values of 11.9 ±5.70 mU/L and 5. 57 ±4. 90 mU/L, respectively, which peaked to an insulin level of 57.9± 46. 6 mU/L and a C-peptide level of 11.75 ± 6. 99 mU/L with stimulation. The pancreas grafts also functioned well as evidenced also by normal serum amylase values of 92. 10 ± 12. 24 U/L on 10th postoperative day. There were five cases of delayed renal graft function. All other patients achieved immediate renal graft function. No graft losses occurred due to leakage or intm-abdominal infection. The most commn surgical complications were wound infection （ n = 11 ）, enteric anastomostic hemorrage （ n = 5）, and peri-renal hemorrage （ n = 2）. Conclusions SPK is a effective treatment option for patients with diabetes mellitus and uremia. Enteric exocrine drainage by direct side-to-side anastomosis （without Roux-en- Y loop） seems to be a simple and reliable technique.

关 键 词：糖尿病 胰腺移植 肠引流 

分 类 号：R617[医药卫生—外科学]