胰肾联合移植术后脾静脉血栓2例报告并文献复习  

SPLENIC VEIN THROMBOSIS AFTER SIMULTANEOUS PANCREAS-KIDNEY TRANSPLANTATION:A REPORT OF TWO CASES AND LITERATURE REVIEW

作　　者：张迪[1] 王建红[1] 杨子祯 吴晓冬[1] 王新[1] 许传屾[1] 蔡金贞 ZHANG Di;WANG Jianhong;YANG Zizhen;WU Xiaodong;WANG Xin;XU Chuan-shen;CAI Jinzhen(Department of Organ Transplantation Center,The Affiliated Hospital of Qingdao University,Qingdao 266100,China)

机构地区：[1]青岛大学附属医院器官移植中心,山东青岛266100

出　　处：《精准医学杂志》2022年第5期408-411,共4页Journal of Precision Medicine

基　　金：青岛大学附属医院青年科学基金(QYFY-2021-36)。

摘　　要：目的探讨胰肾联合移植(SPK)术后患者脾静脉血栓形成的病因、治疗和预后。方法分析2例成年因糖尿病性肾衰竭行SPK术后并发脾静脉血栓形成的患者的临床资料并进行文献复习。结果2例患者均术后第1天出现血淀粉酶、D-二聚体增高,行床旁腹部超声及超声造影检查示脾静脉血栓形成,于术后第2天行剖腹探查术,患者1术中移植胰腺表面及周围邻近组织器官表面见散在灰白色坏死样组织,移植胰腺稍硬,移植胰腺尾部脾静脉内可见血栓形成。患者2术中见移植胰腺呈紫黑色,肿胀明显,表面见散在灰白色坏死样组织,质硬。2例患者均为移植胰腺脾静脉血栓形成,术中决定摘除移植胰腺。术后给予患者抗凝治疗。2例患者移植肾功能良好,分别于术后第24、27天顺利出院。结论血栓形成是SPK术后的严重并发症,是移植物丢失的主要原因,术后应进行密切监测,床旁超声检查为术后血栓形成首选的影像学监测方法。Objective To investigate the etiology,treatment,and prognosis of splenic vein thrombosis after simulta-neous pancreas-kidney transplantation(SPK).Methods An analysis was performed for the clinical data of two adult patients who underwent SPK due to diabetic renal failure and developed splenic vein thrombosis after SPK,and a literature review was also performed.Results Both patients showed increases in blood amylase and D-dimer on day 1 after surgery.Bedside abdominal ultrasound and contrast-enhanced ultrasound showed splenic vein thrombosis,and exploratory laparotomy was performed on day 2 after surgery.The patient 1 showed grayish-white necrotic tissue scattered on the surface of the transplanted pancreas and adjacent tissues and organs,slightly hard transplanted pancreas,and thrombosis in the splenic vein at the tail of the transplanted pancreas.The patient 2 showed a purple-black color of the transplanted pancreas with obvious swelling,grayish-white necrotic tissue scattered on the surface,and hard texture.Both patients had splenic vein thrombosis in the transplanted pancreas,which was removed during laparotomy,and the patients were given anticoagulant therapy after surgery.Both patients had good functions of the transplanted kidney and were successfully discharged on days 24 and 27,respectively,after surgery.Conclusion Thrombosis is a serious complication after SPK and the main cause of graft loss and should be closely monitored after surgery.Bedside ultrasound is the preferred radiological monitoring method for postoperative thrombosis.

关 键 词：肾移植 胰腺移植 脾静脉 静脉血栓形成 超声检查 即时检验 手术后并发症 

分 类 号：R614[医药卫生—麻醉学] R543[医药卫生—外科学]