胰肾联合移植术后并发症的防治(附四例报告)

Prevention and treatment for the postoperative complications of combined pancreas-kidney transplantation

目的探讨肠腔引流式胰肾联合移植术后并发症的防治。方法对4例胰肾联合移植的患者,通过完善术前准备,术后加强抗感染、抗凝,抑制胰液分泌,合理使用免疫抑制剂,密切观察病情变化等措施来防止并发症的发生、发展;对出现的并发症及时地采用相应的治疗措施。结果4例患者中并发巨细胞病毒性肺炎1例、急性排斥反应3例、慢性排斥反应1例,血栓形成1例,1例因肺部感染、呼吸功能衰竭于术后23d死亡,1例移植肾因慢性排斥失功能,其余并发症均治愈。结论术后并发症严重影响着胰肾联合移植的效果,胰肾联合移植术后各种并发症的防治关键在于早期预防、早期诊断、合理治疗。

Objective To study the prevention and treatment for the postoperative complications of combined pancreas - kidney transplantation in the manner of intestinal drainage. Methods Four cases in our centre who received pancreas - kidney co - transplantation were involved in this study, Maneuvers like detailed preoperative preparations, intensive care and postoperative antimicrobial regimen and agents like anticoagulants, pancreatic secretion suppressants, appropriate immunosuppressants were taken to avoid the complications. Additionally, appropriate measures were taken to deal with the complica tions when necessary. Results Among these 4 cases,one suffered postoperative pneumonia infected by cytomegalovirus,3 acute rejection, 1 chronic rejectlon,while 1 thrombosis. One of the 4 cases died on the 23^rd postoperative day of pulmonary infection and then pulmonary failure; the other one failed to get the function from the allografted kidney. All the other complications got treated successfully. Conclusion Postoperative complications probably have bad effect on the outcome of pancreas- kidney co- transplantation. The keys of prevention from postoperative complications lie in early cognition of it, timely diagnosis as well as appropriate treatment.