门静脉回流与体静脉回流对胰肾联合移植效果影响的系统评价  

An Evidence-based Analysis of Simultaneous Pancreas Kidney Transplantation: Portal versus Systemic Venous Drainage of Pancreas Allograft

作　　者：李永胜[1] 李璐璐[1] 黄玉川[1] 唐勇[2] 庞丽丽[1] 赵娜[1] 冯莉[1] 李胜富[1] 龙丹[1] 李幼平[1] 

机构地区：[1]四川大学华西医院卫生部移植工程与移植免疫重点实验室,成都610041 [2]天津医科大学附属肿瘤医院胰腺科,天津300060

出　　处：《中国循证医学杂志》2008年第5期358-363,共6页Chinese Journal of Evidence-based Medicine

基　　金：国家973计划自然科学基金项目(2003CB15504);国家教育部创新研究团队发展计划

摘　　要：目的系统评价胰肾联合移植(simultaneous pancreas–kidney transplantation,SPK)内分泌门静脉回流和体静脉回流两种术式术后移植物存活率、受者存活率和并发症发生率有无区别。方法计算机检索EMbase(1974～2008.1)、PubMed(1970～2008.1)、Cochrane图书馆(2008年第1期)和中国生物医学文献数据库(1978～2008.1),纳入3篇胰肾联合移植内分泌引流两种术式比较的随机对照试验。采用Cochrane协作网的系统评价方法评价纳入研究质量,并提取有效数据进行统计分析。结果最终纳入3个RCT共401例胰肾联合移植进行评价。Meta分析结果显示:胰腺移植内分泌引流的两种术式之间,仅1个研究(共82例)报道门静脉回流术式的3年和5年移植胰腺存活率优于体静脉回流术式(P=0.03,P=0.05),但所有研究的移植胰腺、移植肾脏及受者的各时间点存活率和各种并发症如排斥反应、移植物血栓形成和感染等发生率差异无统计学意义。结论现有研究结果显示,胰肾联合移植内分泌引流两种术式术后移植物存活率、受者存活率和并发症发生率相同。但由于现有临床研究样本量少,上述结论尚需大样本、长期随访的高质量随机对照研究证实。Objective To evaluate the impact of portal or systemic venous pancreas graft drainage on patient and graft outcomes following simultaneous pancreas kidney transplantation （SPK）. Methods We searched The Cochrane Library （2008, Issue 1）, PubMed （1970 to Feb 2008） and EMBASE （1974 to Feb 2008） to find studies concerning the effect of systemic versus portal venous pancreas graft drainage on patient and graft outcomes. Meta-analyses were conducted using The Cochrane Collaboration＇s RevMan 4.2 software. Results Three RCTs involving 401 simultaneous pancreas kidney transplants were induded in our meta-analysis. Statistically significant differences were only observed in 3- and 5-year pancreas graft survival rates （P=0.03 and P=0.05）. No significant difference was noted in patient or kidney graft survival rates. Conclusion Currently available evidences from RCTs does not support the effectiveness of portal drainage in preventing thrombosis, rejection or infection after SPK. Large-scale, long-term and appropriately designed RCTs are required to conclude whether portal and systemic drainage in pancreas transplantation are equivalent in terms of patient and graft survival.

关 键 词：胰肾联合移植 门静脉引流 体静脉引流 并发症 移植物存活率 

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