同种异体胰肾联合移植二例报告

Primary Pancreas-Kidney Transplantation :A Report of 2 Cases

目的:总结胰肾联合移植治疗糖尿病并发晚期肾功能不全病人的临床经验。方法:为2例糖尿病合并糖尿病肾病、肾功能衰竭患者施行胰、肾联合移植术,对手术技术、术后排斥反应的防治和其它非手术并发症的处理进行总结。结果:联合移植后2例胰肾均发挥正常功能,病人均立即停用胰岛素。例1术后发生移植肾急性排斥反应,合并间质性肺炎,移植胰腺胰瘘,胰周感染,死于多器官功能衰竭,例2术后2月时反复出现肉眼血尿、低热,经积极治疗症状消失,目前患者一般情况良好,正常饮食,可从事轻工作。结论:胰肾联合移植是治疗Ⅰ型糖尿病患者并发尿毒症的理想方法。术后并发症是移植失败的主要原因。胰外分泌的处理是胰移植的关键所在。胰液肠腔、膀胱引流式两种术式各有其优缺点,应根据患者的情况及各移植中心的条件选择。

Objective： To summary the experiences of primary pancreas-kidney transplantation. Methods： The combined pancreas-kidney transplantation was performed on 2 patients with diabetes mellitus associated with diabetic nephropathy or renal function failure from Sep. 2003 to Jan. 2004. The treating experiences of the operation skills, prevention of rejection and the management of non-technical complications were summarized. Results： Blood glucose of the two patients decreased to normal level without injection of insulin at 6 or 3 hours after operation. The serum creatinin and nitrogen were at normal level in 5 or 4 days postoperation. The first patients died from complications including pancreas leakage , peripancreatic infection and abscess, and rejection. The other patient have survived 14 months with a good life quality. Conclusion. Combined primary pancreas-kidney transplantation is an effective treatment for insulin-dependent diabetes mellitus patients associated with end-stage of renal failure or diabetic nephropathy.