胰肾联合移植术后外科并发症的单中心临床分析  

Pancreas-kidney transplantation： a single center retrospective analysis of surgical complications

作　　者：郑建明[1] 冯钢[1] 高宇[1] 莫春柏[1] 宋文利[1] 

机构地区：[1]天津市第一中心医院移植外科,300192

出　　处：《中华器官移植杂志》2011年第2期112-114,共3页Chinese Journal of Organ Transplantation

摘　　要：目的对单中心胰肾联合移植术后外科并发症的发生及预后进行评价。方法因糖尿病合并终末期肾病接受胰。肾联合移植的患者共40例，统计患者术后发生的外科并发症以及再次手术治疗的并发症。结果术后出现需要临床处理的严重血尿4例，其中1例经手术行供者十二指肠置管冲洗后止血，2例予持续膀胱冲洗后止血，1例供者十二指肠与膀胱吻合口小动脉出血，手术止血。4例患者出现腹腔内出血，3例为胰腺出血，1例为十二指肠肌层出血，均经手术止血。腹腔感染8例，1例死于多脏器功能衰竭，2例行脓肿穿刺引流后治愈．2例经手术清除脓肿，3例给予抗生素治疗后治愈。术后出现吻合口瘘1例，致胰腺切除。肠梗阻4例，予中药灌肠后治愈。肺部感染7例，均为细菌感染，其中1例合并真菌感染，经抗感染治疗后治愈。另出现伤口愈合不良5例，泌尿系感染2例。胰肾联合移植术后因外科并发症再手术者共10例（14次），再手术率为25％（10／40），主要包括血尿2例（4次手术），腹腔出血4例，腹腔感染2例（3次），胰腺静脉血栓形成、吻合口漏及胰瘘各1例。结论胰肾联合移植术后外科并发症主要包括血尿、腹腔出血、腹腔感染等，是影响胰移植物短期存活率的重要因素。Objective To analyze the complications, treatments and prognosis of simultaneous pancreas-kidney transplantation. Methods Forty cases of simultaneous pancreas-kidney transplantation performed between Dec. 1999 and Jan. 2010 in our center were retrospectively analyzed. Results Regarding surgical complications, 4 cases had severe hematuria after operation, which needed clinical intervention, including 1 patient receiving catheterization in duodenum to stop bleeding. Two patients were treated with continuous bladder irrigation, and the remaining one received surgical haemostasis because of donor＇s duodenum and bladder anastomotic artery hemorrhage. Abdominal hemorrhage occurred in 4 patients, including pancreatic hemorrhage in 3 cases and duodenal muscularis hemorrhage in one case. All of them received surgical treatment for hemostasis. Abdominal infection occurred in 8 cases., one died of multiple organ failure, 2 cases were cured after drainage of abscess, 2 cases underwent surgical removal of abscess, and 3 cases were cured after antibiotic therapy. In one case of postoperative anastomotic leakage, pancreas was resected. Four cases of postoperative ileus were cured by continuous clysis with traditional Chinese medicine. Seven cases had pulmonary bacterial infections, including one cases associated with fungal infection. They were cured by the anti-infective treatment. Other complication included poor healing in 5 cases and urinary infection in 2 cases. After combined simultaneous pancreas-kidney transplantation, 10 patients received reoperation because of surgical complications （14 operations）. The re-operation rate was 25 %, including 2 patients （4 operations） for hematuria, 4 patients for abdominal hemorrhage, 2 patients （3 operations） for abdominal infection, 1 patient for pancreatic venous thrombosis, 1 patient for anastomotic leakage, and 1 patient for pancreatic fistula. Conclusion Although simultaneous pancreas-kidney transplantation provides a successful and effective treatment for diabetics

关 键 词：胰肾联合移植 外科并发症 糖尿病 

分 类 号：R657.5[医药卫生—外科学] R699.2[医药卫生—临床医学]