胰液膀胱引流式胰肾联合移植的远期疗效分析  

Analysis of Long-Term Outcome of Simultaneous Kidney-Pancreas Transplantation with Bladder Drainage

作　　者：张树栋[1] 马潞林[1] 王国良[1] 侯小飞[1] 罗康平[1] 赵磊[1] 

机构地区：[1]北京大学第三医院泌尿外科,北京100083

出　　处：《临床泌尿外科杂志》2009年第2期87-90,共4页Journal of Clinical Urology

摘　　要：目的:探讨胰液膀胱引流式胰肾联合移植的远期效果及其影响因素。方法:2001年9月～2006年1月共为14例患者行同种异体胰、十二指肠及肾联合移植术。胰腺移植于右髂窝,门静脉与髂外静脉做端侧吻合,包括腹腔动脉干和肠系膜上动脉的腹主动脉片与髂外动脉做端侧吻合,肾脏同常规肾移植于左侧髂窝。十二指肠与膀胱侧侧吻合,胰液采用膀胱外引流。术后应用他克莫司加霉酚酸酯加泼尼松三联免疫抑制方案。结果:9例患者术后胰肾功能恢复良好,早期无排斥反应发生。随访18～70个月,平均34个月。存活5年以上者4例,4年以上者5例,3年以上者6例,1年以上者9例,胰肾功能良好,血糖正常,均未使用降糖药。1例因超急性排斥反应术后第2天切除移植胰腺,随访至今2年肾功能良好。4例死亡,其中3例死于心血管事件、多器官衰竭,1例因十二指肠瘘死亡。结论:仔细完善的围手术期管理、预防和及时处理并发症、合理应用免疫抑制剂是影响胰肾联合移植患者和移植物长期存活的重要因素。Objective：To discussed the long term outcome and its impact factors of simultaneous pancreas-kidney transplantation （SPKT） with bladder drainage of pancreatic secretion. Methods：Simultaneous allograft pancreas, duodenum and kidney transplantation was performed in 14 patients from Sept, 2001 to Jan, 2006. The pancreas was transplanted in the right iliac fossa, portal vein and external iliac vein were anastomosed in a end to side manner, including anastomosis of abdominal artery, abdominal aorta of superior mesenteric artery and external lilac artery. The kidney was placed in an intraperitoneal position on the left side according to the standard proce dures. The duodenal segment of the graft was anastomosed side to side to the recipient bladder and pancreatic secretions were managed with bladder drainage. For all patients, immunosuppression therapy was applied by combi nation with tacrolimus, mycophenolate mofetil and prednisone. Results： After surgery, pancreas/kidney function of 9 patients recovered well, and no rejection was found in early stage. After a 18-70-month（mean：34 m） follow up, the number that survived more than 5 years, 4 years, 3 years and 1 year was 4, 5, 6 and 9 respectively. All those patients remained a good pancreas/kidney function and a normal blood sugar level without administration of any hypoglycemic agents. In 1 case, pancreas transplant was removed because of hyperacute rejection while the kidney allograft functioning normally during a 2 year follow-up. There were 3 cases died of heart disease or multiple organs failure, and 1 case died of duodenal fistula. Conclusions：Comprehensive perioperative management, prevention and specific timely treatment of complications, and effective application of immunosuppressant are important factors that link to the outcome of long-term survival of grafts and patients.

关 键 词：肾移植 胰肾联合移植 预后 

分 类 号：R699.2[医药卫生—泌尿科学]