胰腺外分泌引流术式在胰肾联合移植中的应用

Simultaneous Pancreas Kidney Transplantation with Enteric Drainage

目的对同期胰肾联合移植(SPK)胰腺外分泌的不同引流方式进行探讨。方法2000年6月、2003年8月1、1月作者完成的不同术式SPK 3例,术后早期采用四联免疫抑制剂诱导治疗(CsA+MMF+皮质激素+ALG/WT3),以后改为三联维持。结果3例手术均获得成功,2例移植肾功能即刻恢复,3例移植胰功能全部恢复,术后1周内血糖降至正常水平,完全停用外源性胰岛素。1例术后21天带正常移植物功能死于脑梗死,1例术后25天死于感染性休克,1例存活近2年,胰腺外分泌引流为带十二指肠肠道引流(ED)术式。结论带十二指肠ED术式SPK是治疗糖尿病合并尿毒症的理想方法,空肠残端及吻合口置于腹膜外是防止腹腔并发症的有效措施。

Objective To evaluate the surgical technique on modes of pancreatic exocrine secretions and analyse the complications after simultaneous pancreas kidney transplantation （SPK）. Methods Between Jun IDDM/NIDDM） with uremia were involved in the study. They received SPK. Bladder drainage （BD） of pancreatic all graft exocrine. Secretion was used in the first case and enteric drainage （ED） in the two other cases. The patients were treated with quadruple therapy including cyclosporine, mycophenolate mofetil （MMF）, steroid and antilymphocyte globulin （ALG） or WT3. Results The operations for the three patients were all successful and without serious surgical complications. They became insulin-independent 7days after the operation. The first case with BD died of cerebral infarction with normal allograft function three weeks later; the third case with ED died of septic shock twenty five days later; the second case with ED lived for two years with normal allograft function. Conclusion SPK with ED is preferable to diabetes mellitus （IDDM/N1DDM） patients with secondary uremia. Putting the remnant of jejunum and anastomosis out of peritoneal is effective to prevent the compications of peritoneal cavity.