胰肾联合移植术:附19例报告

Simultaneous pancreas-kidney transplantation:a report of 19 cases

目的 探讨胰肾联合移植术中药物的应用方法,以取得良好的术后效果。方法 1 9例胰肾联合移植受者,术中用药如下;以白蛋白(清蛋白)作为主要血管扩容剂,平均用量为1. 5 ~ 2. 0g/kg;电解质溶液输注量为3 0 ~ 5 0mL/kg;用异搏定( 5mg/1 2h)、前列腺素E1 ( 1 0 0μg/1 2h)以减少移植器官的保存损伤;用生长抑素( 3mg/1 2h)抑制移植胰腺外分泌功能。结果 1 9例受者移植胰腺通血后5 ~ 1 0min分泌含高淀粉酶(平均为2 0 8 0 0U/L)的胰液,供肾血管开放后2 ~ 1 0min,输尿管有尿液流出。术后2 ~ 4d肾功恢复,术后1. 5h至9d停用胰岛素。结论 胰、肾联合移植术中合理应用白蛋白、血管扩张剂和生长抑素对移植胰、肾功能有良好作用。

Objective To study the application of intraoperative drug administration in simultaneous pancreas-kidney transplantation(SPK), in order to achieve favorable postoperative results. Methods In the 19 cases of SPK,we primarily administered albumin 1.5~2.0g/kg to increase blood volume. Intraoperative electrocyte fluid dosage was 30~50mL/kg. Isoptin, 5mg/12h and prostaglandin E1(PGE1) 100μg/12h was given to lessen preservation injury and somatostatin(3mg/12h) to inhibit exocrine secretion of the transplanted pancreas. Results After reperfusion,the 19 transplanted pancreas grafts secreted amylase averaging 20 800U/L,and the transplanted kidneys produced urine,through the ureters,in 2~10min.In the 19cases,exogeneous insulin was withdrawn within 1.5h^9d and kidney function returned to normal within 2~4d. Conclusions In the SPK recipients, the rational use of albumin, vasodilators and somatostatin plays an important role in obtaining better function of transplanted pancreas and kidney.