改良的胰液空肠引流式胰腺、十二指肠肾脏一期联合移植1例报告  

Modified simultaneous kidney-pancreatico-duodenal transplantation with enteric drainage of exocrine pancreatic secretions: a case report

作　　者：钱叶勇[1] 石炳毅[1] 蔡明[1] 王亚炜[1] 莫春柏[1] 柏宏伟[1] 常京元[1] 

机构地区：[1]解放军第309医院,北京100091

出　　处：《解放军医学杂志》2004年第2期161-163,共3页Medical Journal of Chinese People's Liberation Army

基　　金：全军医学科研"十五"计划重大项目基金资助课题 (编号 0 1Z0 97)

摘　　要：目的　探讨胰液空肠引流式胰、十二指肠 肾脏一期联合移植的临床技术。方法　对糖尿病终末期肾病患者施行志愿者供体的一期胰、十二指肠及肾联合移植术。胰腺外分泌采用十二指肠和上段空肠直接侧 侧吻合引流 (不用Roux en Y吻合 )。术前应用赛尼哌抗体诱导治疗 ,术后给予FK5 0 6 +骁悉 +泼尼松三联免疫抑制剂方案治疗。结果　术后胰、肾立即发挥功能 ,外源性胰岛素于术后 7天停用 ,肾功能于术后 3天恢复正常 ,未出现严重的外科并发症。术后 35天痊愈出院 ,胰、肾功能良好。结论　改良的胰液空肠引流式胰腺、十二指肠 肾脏一期联合移植安全可靠 ,是治疗胰岛素依赖型糖尿病 (IDDM)并发尿毒症的有效方法。改良术式较传统术式 (采用Roux en Y吻合 )技术简便 ,也可避免胰液膀胱引流术式相关的外科并发症。现代免疫抑制剂的应用和良好的配型可减少并发症的发生。Objective To evaluate the technique of modified simultaneous renal-pancreatico-duodenal transplantation (SKPT) with enteric drinage (ED). Methods Simultaneous pancreaticoduodenal and kidney transplantation of cadaver donors has been performed for one uremic patient with insulin-dependent diabetes mellitus (IDDM). The allograft exocrine secretions were drained into the proximal jejunum via a side-to-side duodenojejunostomy (non Roux-en-Y). The patient received an immunosuppression therapy including zenapax (CD25 antibody), FK506, mycophenolate mofitil (MMF), and predinisone. Results Exogenous insulin was withdrawn on the 7 th day after operation and the renal function became normal on the 3 rd day. No serious surgical complication occurred. 35 days after operation, the patient was discharged with normal pancreatic and renal function. Conclusions (1) The modified ED-SKPT without Roux-en-Y anastomosis is a safe and effective procedure for the treatment uremia accompanied by of IDDM. (2) The modified ED-SKPT (non Roux-en-Y) is simpler than traditional method (with Roux-en-Y) in surgical technique, and it has no operation related complications as seen after BD-SKPT (simultaneous kidney-pancreatico-duodenal transplantation with bladder drainage). (3) Current immunosuppressive agents and good HLA-typing may decrease complications.

关 键 词：糖尿病 胰岛素依赖型 移植 胰腺 肾脏 

分 类 号：R617[医药卫生—外科学]