改良供胰尾端脾动静脉分流术在胰肾联合移植中的临床疗效分析  

Clinical efficacy analysis of modified splenic arteriovenous shunt surgery at the distal end of the pancreatic tail in combined pancreas-kidney transplantation

作　　者：尹威[1] 李萌[1] 方佳丽[1] 李光辉[1] 马俊杰[1] 郭予和 张伟婷[1] 徐璐[1] 刘路浩[1] 陈正[1] Yin Wei;Li Meng;Fang Jiali;Li Guanghui;Ma Junjie;Guo Yuhe;Zhang Weiting;Xu Lu;Liu Luhao;Chen Zheng(Department of Organ Transplantation,the Second Affiliated Hospital of Guangzhou Medical University,Guangzhou 511400,China)

机构地区：[1]广州医科大学附属第二医院器官移植科,广州511400

出　　处：《中华器官移植杂志》2025年第3期219-225,共7页Chinese Journal of Organ Transplantation

基　　金：广州医科大学附属第二医院单中心临床床研研究究项目(2024-LCYJ-ZF-49)。

摘　　要：目的探讨改良供胰尾端脾动静脉分流术在胰肾联合移植中的应用效果。方法回顾2023年11月至2024年10月行供胰尾端脾动静脉分流胰肾联合移植24例(脾动静脉分流组)和2016年起行常规供胰尾端脾动静脉结扎胰肾联合移植231例(脾动静脉结扎组)的临床资料,采用χ2检验或Fisher确切检验比较二组围手术期血栓及严重不良事件发生情况。采用两独立样本t检验,比较脾动静脉分流组和脾动静脉结扎组完成CT灌注成像(CT perfusion,CTP)15例和20例受者的移植胰腺、移植肾功能恢复情况及血流灌注情况。结果脾动静脉分流组受者围手术期脾动静脉血栓形成发生率为0,低于脾动静脉结扎组的4.76%(11/231),组间差异没有统计学意义(P=0.606)。脾动静脉分流组完成CTP者术后1个月时的血淀粉酶水平低于脾动静脉结扎组[(99.61±19.62)比(148.20±70.67)U/L,P=0.018];CTP检查时间点时的脂肪酶和血肌酐水平均高于脾动静脉结扎组[(67.87±32.35)比(45.11±17.94)U/L和(131.79±26.41)比(112.1±24.98)μmol/L,P=0.014和0.034];术后1个月和CTP检查时间点的尿素氮均高于脾动脉结扎组[(11.24±4.64)比(8.51±3.01)mmol/L和(10.41±1.78)比(6.87±1.91)mmol/L,P=0.043和0.001];移植胰腺在胰头及胰尾的血容量均低于脾动静脉结扎组[(15.99±3.51)比(20.67±5.47)ml/100 g和(17.19±4.24)比(27.40±19.80)ml/100 g,P=0.024和0.039]。脾动脉灌注1 min后,脾动静脉分流组脾动脉内血流量和血容量均高于脾动静脉结扎组[(755.85±101.50)比(574.00±142.06)ml·min^(-1)·(100 g)^(−1)和(58.90±19.93)比(23.21±17.02)ml/100 g,P<0.001和P=0.007]。脾动脉灌注2 min后,脾动静脉分流组脾动脉内血流量和血容量亦均高于脾动静脉结扎组[(793.83±68.57)比(503.78±130.80)ml·min^(-1)·(100 g)^(−1)和(64.22±15.74)比(34.32±20.39)ml/100 g,P<0.001和P=0.002]。脾动静脉分流组移植肾上极血流量、血容量、毛细血管表面通透性(permeability of surface,PS)ObjectiveTo evaluate the efficacy of modified splenic arteriovenous shunt surgery at the distal pancreatic tail in combined pancreas-kidney transplantation.MethodsA retrospective analysis was conducted on 24 recipients who underwent combined pancreas-kidney transplantation with the modified splenic arteriovenous shunt at the pancreatic tail from November 2023 to October 2024(shunt group)and 231 recipients who received conventional splenic artery and vein ligation since 2016(ligation group).The incidence of perioperative thrombosis and severe adverse events was compared between the two groups using the chi-square test or Fisher's exact test.Independent sample t-tests were performed to assess postoperative pancreatic and renal function recovery as well as blood perfusion in 15 recipients from the shunt group and 20 from the ligation group who underwent CT perfusion imaging(CTP).ResultsThe incidence of perioperative splenic arteriovenous thrombosis was lower in the shunt group(0)compared to the ligation group(4.76%,11/231),though the difference was not statistically significant(P=0.606).One month postoperatively,the shunt group demonstrated significantly lower serum amylase levels than the ligation group(99.61±19.62 vs.148.20±70.67 U/L,P=0.018).However,at the time of CTP examination,serum lipase(67.87±32.35 vs.45.11±17.94 U/L,P=0.014)and creatinine levels(131.79±26.41 vs.112.1±24.98μmol/L,P=0.034)were significantly higher in the shunt group.Urea nitrogen levels were also significantly higher in the shunt group both one month postoperatively(11.24±4.64 vs.8.51±3.01 mmol/L,P=0.043)and at the CTP examination(10.41±1.78 vs.6.87±1.91 mmol/L,P=0.001).Regarding pancreatic perfusion,blood volume in both the pancreatic head(15.99±3.51 vs.20.67±5.47 ml/100 g,P=0.024)and tail(17.19±4.24 vs.27.40±19.80 ml/100 g,P=0.039)was significantly lower in the shunt group.After one minute of splenic artery perfusion,the shunt group exhibited significantly higher splenic artery blood flow(755.85±101.50 vs.574.00±142.06 ml�

关 键 词：胰肾联合移植 胰尾 脾动静脉分流术 血栓形成 CT灌注成像 

分 类 号：R657.3[医药卫生—外科学]