上腹部器官簇联合肾脏移植治疗多器官病变的临床分析  

Clinical analysis of combined upper abdominal cluster and kidney transplantation

作　　者：李江[1] 郭庆军[1] 蔡金贞[1] 郑虹[1] 潘澄[1] 沈中阳[1] 蒋文涛[1] Li Jiang, Guo Qingjun, Cai Jinzhen, Zheng Hong, Pan Cheng, Shen Zhongyang, Jiang Wentao.(Organ Transplantation Center, Tianjin First Center Hospital, Tianjin Key Laboratory for Organ Transplantation, Tianjin Clinical Research for Organ Transplantation, Tianjin 300192, China.)

机构地区：[1]天津市第一中心医院肝移植科,天津市器官移植重点实验室,天津市器官移植临床医学研究中心,天津300192

出　　处：《实用器官移植电子杂志》2018年第1期34-38,共5页Practical Journal of Organ Transplantation(Electronic Version)

基　　金：国家自然科学基金项目(81400680);天津市自然科学基金项目(17JCQNJC12800)

摘　　要：目的研究腹部器官簇(肝、胰、十二指肠)及肾脏一期联合移植治疗肝炎后肝硬化并发尿毒症伴胰岛素依赖型糖尿病的外科技术和临床效果。方法 2016年7月对1例肝炎后肝硬化并发尿毒症伴胰岛素依赖型糖尿病的患者进行了肝、胰、十二指肠及肾脏联合移植,受者切除患肝后,原位植入包括肝脏、胰腺、部分十二指肠的器官簇,肝脏移植采用经典原位肝移植术式,受体门静脉与供肝门静脉采用端侧吻合,器官簇的肝总动脉与肠系膜上动脉采用髂血管成型成统一开口后与受体肝总动脉吻合。胆道和胰腺外引流采用供者十二指肠与受者上段空肠Roux-en-Y侧侧吻合方式。肾移植采用传统异位肾移植术,器官簇与肾脏来源于同一个供者。免疫抑制方案采用术中巴利昔单抗诱导,术后他克莫司(Tac)+吗替麦考酚酯(MMF)+激素联合应用预防排斥反应。结果患者于术后2周,肝肾功能指标恢复至正常范围,术后3周完全脱离胰岛素治疗,并且血糖水平维持正常。结论腹部器官簇移植是治疗终末期肝病合并胰岛素依赖的2型糖尿病的有效手段。Objective To study the surgical technique and clinical effect of combined transplantation of abdominal organ cluster（liver, pancreas-duodenum） and kidney for the treatment of posthepatitic cirrhosis combined with uremia and insulin-dependent diabetes mellitus. Methods A patient suffered from Hepatitis B cirrhosis, uremia and insulin-dependent diabetes mellitus underwent abdominal organ cluster and kidney transplantation in July, 2016. After the patient＇s liver was removed, the organ cluster involving liver, pancreas and duodenum was implanted orthotopically. The hepatic vein of liver was anatomosed in classic pattern. The recipient＇s portal vein was then anastomosed to the side of the donor portal vein above the upper border of donor pancrea. The common hepatic artery and superior mesenteric artery of graft were reconstructedwith branches of an iliac artery and their common trunck was anastomosed to the recipientt＇s common hepatic artery. The side wall of graft duodenum was anastomosed to of the side wall of native proximal jejunum in manner of Roux-en-Y. The kidney graft was placed in right iliac fossa. Abdominal organ cluster and kidney were from a same donor. A quadruple immunosuppressive regimen including anti-IL-2 receptor antibody（simulect）, tacrolimus, mycophenolate mofetil（MMF） and steroids was employed to prevent rejection. Results Two weeks after the operation, the liver and kidney functions returned to their normal ranges. Insulin was weaned off 3 weeks after operation, and the blood glucose level remained normal after that. Conclusion Combined abdominal organ cluster and kidney transplantation was an effective method to treat end-stage liver disease, uremia and type 2 diabetes mellitus.

关 键 词：器官簇移植 肝 胰十二指肠 肾脏 肝功能衰竭 2型糖尿病 尿毒症 

分 类 号：R699.2[医药卫生—泌尿科学]