肠引流式同期胰肾联合移植后胰十二指肠吻合口痿治愈的一例并文献复习  

Cure ofpancreaticoduodenal anastomotic leakage after simultaneous pancreas-kidney transplantation with enteric drainage: a case report and literature review

作　　者：李德胜 张善斌[1] 曾凡军 王毅[1] 肖劲逐[1] 徐剑 刘厚琴 徐亮 曹鹏 张化军 Li Desheng;Zhang Shanbin;Zeng Fanjun;Wang Yi;Xiao Jinzhu;Xu Jian;Liu Houqin;Xu Liang;Cao Peng;Zhang Huajun(Second Affiliated Hospital, Hainan Medical University, Haikou 571000, China)

机构地区：[1]海南医学院第二附属医院,海口571000

出　　处：《中华器官移植杂志》2019年第5期280-283,共4页Chinese Journal of Organ Transplantation

摘　　要：目的总结1例肠引流术式同期胰肾联合移植(SPK)术后吻合口肠瘘的治愈经验。方法回顾性分析1例2型糖尿病合并终末期肾病接受SPK的病例资料,供胰静脉回流采用髂静脉体循环途径,移植胰腺外分泌经肠道引流,供胰十二指肠与受者空肠侧侧吻合,术后第12天出现移植胰十二指肠吻合口瘘,二次手术改行供胰十二指肠与受者空肠Roux-en-Y吻合。结合国内外相关文献资料进行分析研究。结果二次术后随访时间3个月,受者移植胰腺和移植肾的存活良好,治愈出院。国内外不同移植中心该吻合口瘘发病率差异较大,发生率在3.6%~11.3%之间,胰腺丢失风险较高在0~54.6%之间。结论SPK术后吻合口瘘是严重并发症,易导致严重腹腔感染,肠瘘修补后再漏风险仍较高,Roux-en-Y吻合可作为一种治疗手段。Objective To summarize the experience of one case of anastomotic leakage after simultaneous pancreas-kidney transplantation (SPK) with enteric drainage. Methods One case of type 2 diabetes mellitus complicated with end-stage nephropathy undergoing SPK was retrospectively analyzed. Iliac venous systemic circulation was employed for pancreatic venous reflux, transplanted pancreas exocrine via enteric drainage and side-to-side anastomosis between donor pancreaticoduodenum and recipient jejunum. Pancreatoduodenal anastomotic leakage occurred at 12 days post-operation. During re-operation, Roux-en-Y anastomosis was established between donor pancreaticoduodenum and recipient jejunum. And the relevant domestic and foreign literatures were searched. Results The follow-up time was 3 month after a second operation. Recipient pancreas and kidney transplantation survived well. There was no onset of enteric leakage. The incidence of anastomotic leakage varies greatly between different transplantation centers both at home and abroad. The incidence ranged from 3.6% to 11.3%. And the risk of pancreatic loss was as high as 54.6%. Conclusions As a severe postoperative complication, anastomotic fistula after SPK may cuase abdominal infection. Even after reparing enteric fistula, the risk of leakage remains high. Roux-en-Y anastomosis is other therapeutic option.

关 键 词：胰肾联合移植 胰腺 十二指肠 吻合口瘘 

分 类 号：R699.2[医药卫生—泌尿科学] R657.5[医药卫生—外科学]