两种胰液引流术式的胰肾联合移植临床效果比较  

Comparison of clinical effects of two simultaneous pancreas-kidney transplantation methods for pancreatic fluid drainage

作　　者：蓝柳根[1] 李美思 高照 董建辉 秦科[1] 黄莹[1] 曹嵩 李海滨 雷志影 孙煦勇 Lan Liugen;Li Meisi;Gao Zhao;Dong Jianhui;Qin Ke;Huang Ying;Cao Song;Li Haibin;Lei Zhiying;Sun Xuyong(Transplant Medical Center of The Second Affiliated Hospital of Guangxi Medical University,Guangxi Clinical Research Center for Organ Transplantation,Guangxi Key Laboratory of Organ Donation and Transplantation,Nanning 530007,Guangxi,China)

机构地区：[1]广西医科大学第二附属医院移植医学中心,广西器官移植临床医学研究中心,广西器官捐献与移植研究重点实验室,广西南宁530007

出　　处：《实用器官移植电子杂志》2023年第6期514-518,共5页Practical Journal of Organ Transplantation(Electronic Version)

基　　金：广西医学高层次骨干人才培养“139”计划培养项目(G202002016);广西自然科学基金区域高发疾病研究联合专项资助(2023GXNSFAA026142)。

摘　　要：目的 分析53例糖尿病并终末期肾病患者行同期胰肾联合移植不同胰液引流术式的临床效果对比。方法 2010年5月至2019年12月广西医科大学第二附属医院移植医学中心完成了53例同期胰肾联合移植手术,其中胰液膀胱引流(bladder drainage,BD)术式22例,胰液空肠引流(enteric drainage,ED)术式组31例。对比两组不同胰液引流术式受者的移植肾功能延迟恢复发生率、术后移植胰腺功能延迟恢复发生率、胰腺冷缺血时间、移植胰腺1年生存率、手术时间、再手术率、术中总输血量、术后1个月血糖变化、其他并发症等。结果 53例胰肾联合移植手术成功,随访4~90个月,在22例BD术式中,有1例患者发生坏死性胰腺炎,切除胰腺。3例患者出现移植肾功能延迟恢复,有1例患者移植肾功能延迟恢复,恢复有尿后发生出血性膀胱炎,后并发肺部感染而死亡。移植后(14.2±5.1)d空腹血糖降至正常,(9.5±4.2)d停止使用胰岛素,(10.4±6.5)d肾功能恢复正常。平均住院时间为(21.4±7.3)d,术后出现并发症有移植胰腺静脉血栓2例,泌尿系感染1例,移植胰淋巴漏1例,切口感染1例,他克莫司中毒1例、移植肾急性排斥反应1例。21例患者长期存活。在31例ED术式组中,术后(12.2±5.1)d空腹血糖降至正常,(7.3±3.2)d停止使用胰岛素,(11.2±5.7)d肾功能恢复正常。平均住院时间为(18.6±6.6)d,2例患者术后出现移植胰腺静脉血栓形成,切除胰腺。2例患者出现坏死性胰腺炎,切除胰腺。移植肾急性排斥反应(经活检证实)2例,移植胰切口感染2例,他克莫司中毒1例。31例患者长期长期存活。结论 胰肾联合移植胰液空肠引流术式组受者并没有增加手术风险,且受者及移植物存活率未受影响,患者生活质量高于膀胱引流组,胰肾联合移植手术胰液空肠引流术式的临床效果和安全性较好,临床上值得推广。Objective To summarize and analyze the clinical efficacy of simultaneous pancreaskidney transplantation(SPK) with different drainage methods in 53 patients with diabetic nephropathy.Methods From May 2010 to December 2019,53 simultaneous pancreas-kidney transplantation surgeries were completed at the Transplant Medical Center of The Second Affiliated Hospital of Guangxi Medical University.There were 22 cases in pancreatic fluid bladder drainage(BD)surgery group and 31 cases in pancreatic fluid jejunal drainage(ED)surgery group.The patients were treated with anti lymphocyte globulin or anti-CD25 monoclonal antibody during the operation,and tacrolimus,mycophenolate mofetil and glucocorticoid triple immunosuppressive regimen were used in the early stage.The 1-year survival rate,delayed recovery of pancreas function,incidence of delayed renal function recovery(DGF),operation time,pancreatic cold ischemia time,reoperation rate,intraoperative total blood transfusion,blood glucose change trend in one month after operation,and other complications were compared between the two groups.Results A total number of 53cases were operated successfully.All patients were followed up for 2 to 60 months.Among them,22 cases were performed with pancreatic juice bladder drainage(BD).One patient developed necrotizing pancreatitis,and the pancreas was resected.After 6 months,pancreas transplantation was successful.Three recipients had delayed recovery of renal allograft function after operation.One patient had delayed recovery of renal function.Bladder mucosal bleeding occurred after urination recovery.After three times of interventional embolization,pulmonary infection occurred and the patient died.Pancreatic and renal functions were normal at the time of death.The rest of the patients survived and their fasting blood glucose returned to normal at(14.2 ± 5.1) d,(9.5 ± 4.2) d after surgery,and serum creatinine returned to normal after(10.4 ± 6.5) d.The average length of hospital stay was(21.4±7.3) d.Postoperative complications included

关 键 词：同期胰肾联合移植 胰液引流方式 临床疗效 

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