同侧胰肾联合移植40例临床经验总结  

Preliminary clinical experience of ipsilateral simultaneous pancreas and kidney transplantation

作　　者：张磊[1] 陈正[1] 马俊杰[1] 方佳丽[1] 李光辉[1] 徐璐[1] 赖兴强[1] 尹威[1] 熊韫祎 刘路浩[1] 李立[1] 陈荣鑫[1] 张鹏 徐海林 张滔 万娇 潘光辉[1] Zhang Lei;Chen Zheng;Ma Junjie;Fang Jiali;Li Guanghui;Xu Lu;Lai Xingqiang;Yin Wei;Xiong Yunyi;Liu Luhao;Li Li;Chen Rongxin;Zhang Peng;Xu Hailin;Zhang Tao;Wan Jiao;Pan Guanghui(Second Affiliated Hospital, Guangzhou Medical University, Guangzhou 510260, China)

机构地区：[1]广州医科大学第二附属医院,510260

出　　处：《中华器官移植杂志》2019年第5期266-271,共6页Chinese Journal of Organ Transplantation

基　　金：广东省科技计划项目(2014A020212319).

摘　　要：目的探讨同侧胰肾联合移植(SPK)术式的临床应用效果,总结相关经验。方法对2016年9月至2018年8月40例采用同侧SPK术式的受者进行随访,总结该术式的疗效及并发症情况。结果随访时间6~29个月,38例受者取得较好的临床疗效,2例受者术后死于重症肺炎。术后3、6、12和24个月时受者的血肌酐水平分别为107、102、107和110 μmol/L,肌酐清除率分别为64、67、64和63 ml/min,空腹血糖分别为4.6、5.1、4.6和5.2 mmol/L,糖化血红蛋白为4.8%、5.4%、4.9%、5.2%。受者、移植胰腺及移植肾术后1年和2年累积存活率均为92%。术后并发症以内科并发症为主,其中发生移植肾急性排斥反应(AR)11例,移植胰腺AR12例,二者同时出现排斥反应6例;发生移植肾功能恢复延迟(DGF)1例,肺部感染14例,泌尿系感染18例,消化道出血10例,腹泻6例,脾静脉血栓2例,移植肾输尿管不全梗阻3例,尿漏1例,以及移植胰功能不全2例。无重大外科并发症,所有外科并发症经对症处理后均获得满意效果,所有受者无一例切除移植肾或移植胰腺。结论同侧SPK术式的治疗效果确切,具有较好的推广价值。Objective To preliminarily explore the clinical efficacy of ipsilateral simultaneous pancreas and kidney transplantation (SPK). Methods Ipsilateral SPK was performed in 40 patients from September 2016 to August 2018. During a follow-up period of 6 to 29 months, we summarized the efficacy and complications of the technique. Results Up to now, 38 patients achieved an exceelent clinical efficacy with no major surgical complications. However, two patients died of severe pneumonia. The postoperative serum levels of creatinine at 3, 6, 12, 24 months were 107, 102, 107, 110 umol/L;creatinine clearance rate 64, 67, 64, 63 ml/min;fasting glucose 4.6, 5.1, 4.6, 5.2 mmol/L;glycated hemoglobin 4.8%, 5.4%, 4.9%, 5.2% respectively. And 1/2-year pancrea and kidney graft survival rates both were 92%. Complications included kidney graft rejection (n=11), pancreas graft rejection (n=12), simultaneous renal & pancreas graft rejection (n=6), renal graft DGF (n=1), pulmonary infection (n=14), urinary tract infections (n=18), gastrointestinal bleeding (n=10) diarrhea (n=6), splenic venous thrombosis (n=2), incomplete ureteric obstruction of renal allograft (n=3), urine leakage (n=1) and pancreas allograft dysfunction (n=2). There were no severe surgical complications. After aggressive interventions, all postoperative complications were cured and none required excision of kidney or pancreas. Conclusions Ipsilateral SPK has definite therapeutic efficacy and it is worth wider popularization.

关 键 词：胰肾联合移植 同侧 肾功能 胰腺功能 手术并发症 

分 类 号：R657.5[医药卫生—外科学]