同侧胰肾联合移植146例临床效果分析  

Clinical effect analysis of 146 cases of ipsilateral simultaneous pancreas and kidney transplantation

作　　者：方佳丽[1] 郭予和 马俊杰[1] 李光辉[1] 张磊[1] 徐璐[1] 尹威[1] 赖兴强[1] 张异蕊 刘路浩[1] 熊韫祎 李立[1] 陈荣鑫[1] 张滔 张鹏 徐海林 万娇 吴佳林[1] 潘光辉[1] 陈正[1] 石炳毅[2] Fang Jiali;Guo Yuhe;Ma Junjie;Li Guanghui;Zhang Lei;Xu Lu;Yin Wei;Lai Xingqiang;Zhang Yirui;Liu Luhao;Xiong Yunyi;Li Li;Chen Rongxin;Zhang Tao;Zhang Peng;Xu Hailin;Wan Jiao;Wu Jialin;Pan Guanghui;Chen Zheng;Shi Bingyi(Organ Transplant Center,the Second Affiliated Hospital of Guangzhou Medical University,Guangzhou 510260,China;Department of Organ Transplantation Institute,the 8th Medical Center,Chinese PLA General Hospital,Beijing 100091,China)

机构地区：[1]广州医科大学附属第二医院,广州510260 [2]解放军总医院第八医学中心器官移植研究室,北京100091

出　　处：《中华医学杂志》2020年第48期3853-3858,共6页National Medical Journal of China

基　　金：广州市临床重大科技项目(2019ZD12);广东省医学科学技术研究基金(A2020384)。

摘　　要：目的探讨同侧胰肾联合移植术的临床效果和安全性。方法选择2016年9月至2020年6月广州医科大学附属第二医院器官移植中心完成的146例胰肾联合移植手术受者作为对象,总结同侧胰肾联合移植手术方式受者的结局、疗效及并发症。结果受者随访1~45个月,取得良好的临床效果。肾功能指标提示,血清肌酐在术后第7天恢复至142.4(108.6,213.4)μmol/L。胰腺功能指标如期下降至参考范围。血淀粉酶在术后7 d内偏高,为160.5(109.3,249.8)U/L,随后下降,尿淀粉酶趋势与血淀粉酶相似,术后第7天为240(121.0,370.0)U/L;糖化血红蛋白术后1个月下降至参考范围内,为5.8%±1.4%,主要内科并发症为感染[肺部感染26.03%(38/146),泌尿系感染26.03%(38/146),腹腔感染4.79%(7/146)]、急性排斥反应[移植肾急性排斥反应5.8%(8/146),移植胰/十二指肠急性排斥反应18.49%(27/146),移植肾合并移植胰急性排斥反应6.85%(10/146)]、消化道出血30.82%(45/146),其中严重出血3.42%(5/146)。主要外科并发症为切口愈合不良,占10.27%(15/146),严重的外科并发症为移植胰动静脉血栓形成,占2.05%(3/146),肠漏占0.68%(1/146)。1、3年人、肾、胰腺生存率均分别为92.5%、91.5%、89.0%,死亡删除的移植肾1、3年生存率为均为99.3%,死亡删除的胰腺1、3年生存率均为95.0%。结论严格供受者器官功能的评估,积极预防、诊断和处理内外科并发症,同侧胰肾联合移植的术式具有手术操作更简单、并发症发生率更低等优势,可取得良好的临床效果。Objective To investigate the clinical effect of ipsilateral simultaneous pancreas and kidney transplantation(SPK).Methods A total of 146 cases of SPK surgeries completed in the Second Affiliated Hospital of Guangzhou Medical University from September 2016 to June 2020 were selected to summarize the outcome,curative effect and complications of the operation.Results The patients were followed up for 1 to 45 months.Good clinical results were obtained in 146 patients.Renal function indicators suggest that on the 7th day after operation,the serum creatinine returned to normal level[142.4(108.6,213.4)μmol/L].The index of pancreatic function decreased to the normal level as expected.The level of blood amylase was 160.5(109.3,249.8)U/L within 7 days after operation,and then decreased.The trend of urinary amylase was similar to that of blood amylase,which was 240(121.0,370.0)U/L 7 days after operation,and glycosylated hemoglobin decreased to the normal level(5.8%±1.4%)1 month after operation.The main medical complications were infection including pulmonary infection(26.03%,38/146),urinary tract infection(26.03%,38/146),and abdominal infection(4.79%,7/146),acute rejection including renal graft rejection(5.8%,8/146),pancreas/duodenum rejection(18.49%,27/146),and renal graft combined pancreatic graft rejeciton(6.85%,10/146),as well as gastrointestinal bleeding(30.82%,45/146),of which 5 cases were severe bleeding(3.42%,5/146).The main surgical complications were poor incision healing(10.27%,15/146),serious surgical complications including arteriovenous thrombosis of the transplanted pancreas(2.05%,3/146)and intestinal leakage(0.68%,1/146).The 1-year and 3-year patient,renal and pancreatic survival rates were both 92.5%,91.5%and 89.5%,respectively,and despite the death,the 1-year,3-year transplanted kidney survival rate was both 99.3%,and 95%for the the 1-year,3-year pancreas survival rate.Conclusion Strict preoperative evaluation of the function of large organs,reasonable surgical methods,perioperative anticoagulation,and p

关 键 词：胰腺移植 肾移植 肾功能 胰腺功能 并发症 

分 类 号：R657.5[医药卫生—外科学] R699.2[医药卫生—临床医学]