改良上腹部多器官移植治疗终末期肝病合并糖尿病的长期疗效分析  

Long-term clinical outcomes of combined ＇en bloc＇ liver and pancreas transplantation in 19 patients with end-stage liver disease and diabetes mellitus

作　　者：何晓顺[1] 陈知水[2] 鞠卫强[1] 林建伟[1] 朱晓峰[1] 王东平[1] 马毅[1] 巫林伟[1] 邰强[1] 郭志勇[1] 韩明[1] 魏来[2] 王国栋[1] 王小平[1] 

机构地区：[1]中山大学附属第一医院器官移植中心,广州510080 [2]华中科技大学同济医学院附属同济医院器官移植研究所

出　　处：《中华器官移植杂志》2014年第11期644-649,共6页Chinese Journal of Organ Transplantation

基　　金：广东省器官捐献与移植免疫重点实验室建设项目，公益性行业科研专项基金

摘　　要：目的探讨改良上腹部多器官移植治疗终末期肝病合并糖尿病的临床长期疗效。方法回顾性分析19例改良上腹部多器官移植受者的临床资料。19例受者的原发病为乙型肝炎后肝硬化9例，肝细胞癌7例，以及胆管细胞癌、酒精性肝硬化和肝移植术后胆道并发症各1例，术前肝功能Child-Pugh分级为A级2例、B级13例及C级4例，终末期肝病模型评分为（8．2±4．6）分；所有受者均合并有2型糖尿病，糖尿病病程为（4．0±3．6）年，均使用胰岛素控制血糖，术前糖化血红蛋白（HbA1c）为（7．9±1．7）％，C肽为（0．68±0．40）nmol／L。术中予保留受者胰腺和全消化道，行单纯肝脏切除后，进行上腹部多器官（包括肝、胰、十二指肠降部和水平部）移植，使用供者髂内外动脉分叉部分将腹腔干和肠系膜上动脉修整为一个骼总动脉开口，通过该开口与受者肝总动脉行端端吻合。术后检测肝肾功能、血糖、C肽等指标，监测感染、排斥反应、血管并发症及胆道并发症等发生情况。结果术后对所有受者进行了（25．8±25．4）个月（1～96个月）的随访，其中18例于术后2周内停用胰岛素，空腹及餐后血糖恢复至基本正常水平，术后3个月HbAlc为（5．0±0．3）％，较术前明显改善（P〈0．05）；术后3个月C肽为（1．20±0．78）nmol／L，较术前显著升高（P〈O．05）；1例于术后1．5个月复查时仍使用胰岛素24U／d控制血糖。术后1周丙氨酸转氨酶、天冬氨酸转氨酶及胆红素总量等肝功能指标趋于正常水平。随访过程中共有3例死亡，1例术后1个月时死于移植物抗宿主病，1例术后12．5个月死于急性单核细胞白血病，1例术后26个月死于皮质激素冲击治疗急性排斥后继发的消化道穿孔及腹膜炎；随访中未发现胆道并发症。术后1、3、5年累积存活率分别为94．7％、76．oVo和76．0％。结论保�Objective To investigate the clinical efficacy of combined en-bloc liver-pancreas transplantation in patients with end-stage liver disease and diabetes mellitus. Method The clinical data of 19 cases of combined en-bioc liver-pancreas transplantation were retrospectively analyzed. The primary diseases of 19 cases included 9 cases of liver cirrhosis after hepatitis B, 7 cases of hepatocellular carcinoma, and cholangiocellular carcinoma, and alcoholic cirrhosis of the liver and biliary complications after liver transplantation in 1 case each. All patients were rendered dependent from insulin therapy （62. 3 ±26. 8 U/day） before transplantation, and duration of diabetes mellitus was （4. 0 ± 3. 6） years. Mean levels of glycosylated hemoglobin and C-peptide in all recipients were （7.9 ± 1.7）% and （0.68 ± 0.40） nmol/L before transplantation. The pancreas and the whole digestive tract of the recipients were reserved. The liver and pancreas duodenal organ cluster grafts were implanted after the resection of the diseased liver. The liver and kidney function, blood glucose, C-peptide, infection, rejection, vascular complications, biliary complications and other indicators were monitored postoperatively. Result Median posttransplant follow-up was currently 25.8 ± 25.4 months （1 to 96 months）. From two weeks after operations, no insulin was used in 18 patients, and the blood glucose levels returned to almost normal. Mean glycosylated hemoglobin values decreased from pretransplant （7. 9 ± 1.7）% to （5.0 ± 0. 3）% 3 months posttransplantation （P〈0. 05）. Mean C-peptide values increased from pretransplant 0. 68 ± 0. 40 nmol/L to 1.20 ± 0. 78 nmol/L 3 months posttransplantation （P 〈 0. 05）] There was only one recipient （5. 3% ） who remained exogenous insulin （24 U/day） dependence 45 days posttransplantation. Alanine aminotransferase （ALT）, aspartate aminotransferase （AST） and total bilirubin became normal after one week. So far of the followed up, there was no bilary co

关 键 词：腹部 器官移植 肝硬化 糖尿病 

分 类 号：R657.3[医药卫生—外科学] R587.1[医药卫生—临床医学]