Exocrine drainage in pancreas transplantation:Complications and management  

作　　者：Joana Ferrer-Fàbrega Laureano Fernández-Cruz 

机构地区：[1]HepatoBiliaryPancreatic Surgery and Liver and Pancreas Transplantation Department,ICMDM,Hospital Clinic Barcelona,University of Barcelona,Barcelona Clinic Liver Cancer Group,August Pi i Sunyer Biomedical Research Institute,Barcelona 08036,Barcelona,Spain [2]Department of Surgery,ICMDM,Hospital Clinic Barcelona,Barcelona 08036,Barcelona,Spain

出　　处：《World Journal of Transplantation》2020年第12期392-403,共12页世界移植杂志

摘　　要：The aim of this minireview is to compare various pancreas transplantation exocrine drainage techniques i.e.,bladder vs enteric.Both techniques have different difficulties and complications.Numerous comparisons have been made in the literature between exocrine drainage techniques throughout the history of pancreas transplantation,detailing complications and their impact on graft and patient survival.Specific emphasis has been made on the early postoperative management of these complications and the related surgical infections and their consequences.In light of the results,a number of bladder-drained pancreas grafts required conversion to enteric drainage.As a result of technical improvements,outcomes of the varied enteric exocrine drainage techniques(duodenojejunostomy,duodenoduodenostomy or gastric drainage)have also been discussed i.e.,assessing specific risks vs benefits.Pancreatic exocrine secretions can be drained to the urinary or intestinal tracts.Until the late 1990s the bladder drainage technique was used in the majority of transplant centers due to ease of monitoring urine amylase and lipase levels for evaluation of possible rejection.Moreover,bladder drainage was associated at that time with fewer surgical complications,which in contrast to enteric drainage,could be managed with conservative therapies.Nowadays,the most commonly used technique for proper driving of exocrine pancreatic secretions is enteric drainage due to the high rate of urological and metabolic complications associated with bladder drainage.Of note,10%to 40%of bladder-drained pancreata eventually required enteric conversion at no detriment to overall graft survival.Various surgical techniques were originally described using the small bowel for enteric anastomosis with Roux-en-Y loop or a direct side-to-side anastomosis.Despite the improvements in surgery,enteric drainage complication rates ranging from 2%-20%have been reported.Treatment depends on the presence of any associated complications and the condition of the patient.Intra-abdom

关 键 词：Graft survival Patient survival Anastomotic leak MORBIDITY INFECTION SURGERY 

分 类 号：R57[医药卫生—消化系统]