胰腺移植的技术难点与挑战  

Technical dilemmas and challenges of pancreas transplantation

作　　者：康志强 赵唐 张秋 虞茂林 赵薪皓 杨洪吉 朱世凯 Zhi-Qiang Kang;Tang Zhao;Qiu Zhang;Mao-Lin Yu;Xin-Hao Zhao;Hong-Ji Yang;Shi-Kai Zhu(Organ Transplant Center,Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital,University of Electronic Science and Technology of China,Chengdu 610072,Sichuan Province,China)

机构地区：[1]电子科技大学附属医院·四川省人民医院器官移植中心,四川省成都市610072

出　　处：《世界华人消化杂志》2024年第11期797-802,共6页World Chinese Journal of Digestology

基　　金：四川省自然科学基金面上项目,No.2024NSFSC07442.

摘　　要：本研究系统剖析了胰腺移植预后的关键决定因素及常见术后并发症.我们通过综合分析糖尿病类型、性别匹配、受体身体质量指数(body mass index,BMI)、热缺血时间、灌洗液类型以及手术顺序等变量,结果显示糖尿病类型对胰腺移植受者及移植物存活率无显著独立影响;性别组合中,供受双方均为男性时,患者术后五年生存率似有优势;而双方均为女性时,则面临更高的早期开腹手术率及胰腺血栓风险.此外,优化BMI管理、缩短热缺血时间、选择Institut Georges Lopez-1(IGL-1)液作为灌洗液及调整手术顺序(如优先肾后胰腺移植)均为提升预后的有效策略.术后主要并发症涵盖急性免疫排斥反应(发生率为15%-21%)、血管栓塞(7.07%)、腹腔出血及移植物胰腺炎,需采取个性化措施加以应对,包括强化免疫抑制治疗、优化抗凝方案、调整抗凝药物剂量及实施禁食与生长抑素治疗.尤为重要的是,术后新发恶性肿瘤与免疫抑制剂的长期应用密切相关,故需实施长期随访监测.本研究为胰腺移植技术的精细化改进及术后综合管理策略的制定提供了坚实的科学基础.This paper systematically analyzes the key prognostic determinants and common postoperative complications of pancreatic transplantation.A comprehensive analysis of variables such as diabetes type,gender matching,recipient body mass index,hot ischemia time,lavage fluid type,and surgical sequence shows that diabetes type has no significant independent effect on the survival rate of pancreatic transplantation recipients and grafts.In the gender combination,when both donors and recipients are male,the 5-year survival rate seems to be superior.When both partners are women,they face a higher rate of early laparotomy and a higher risk of pancreatic thrombosis.In addition,optimizing body mass index management,shortening the duration of hot ischemia,selecting Institut Georges Lopez-1 solution as lavage solution,and adjusting the surgical sequence(e.g.,retrorenal pancreas transplantation is preferential)are all effective strategies to improve prognosis.The major postoperative complications include acute immune rejection(15%-21%),vascular embolism(7.07%),abdominal hemorrhage,and graft pancreatitis,which require individualized measures,including intensive immunosuppressive therapy,opti-mization of anticoagulant regimen,adjustment of antico-agulant dose,fasting,and somatostatin therapy.It is particularly important that postoperative newly developed malignant tumors are closely related to the long-term use of immunosuppressants,so long-term follow-up monitoring should be implemented.This article provides a solid scientific basis for the refinement and improvement of pancreatic transplantation techniques and the formulation of postoperative comprehensive management strategies.

关 键 词：胰腺移植 糖尿病 术后并发症 预后因素 

分 类 号：R657.5[医药卫生—外科学]