胰肾一期联合移植

Simultaneous pancreas-kidney transplantation.

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疗效，并探讨分析术后并发症防治经验。方法对５例糖尿病并发晚期肾功能不全者采用胰十二指肠肾一期联合移植。免疫抑制方案采用激素、ＣｓＡ及硫唑嘌呤或激素、ＣｓＡ及骁悉三联用药。结果联合移植后５例胰肾均发挥正常功能，病人均立即停用胰岛素。１例术后发生移植肾急性排斥反应，死于多器官功能衰竭，余４例分别发生胰周脓肿、急性胰腺炎、十二指肠瘘、血尿等并获治愈。其中２例至今已分别存活４年９个月和３年８个月。结论胰肾一期联合移植对糖尿病并发晚期肾功能不全具有肯定的治疗价值。十二指肠膀胱引流胰腺外泌具有许多优点，严密的术后监测及并发症的有效防治是提高移植物及病人长期存活的关键。

Objective To review the effects of simultaneous pancreas-kidney transplantation(SPK)to treat the uremic diabetic patients and to outline the strategies for preventing and managing complications.Methods SPK with bladder drainage were performed in 5 uremic diabetic patients.The triple immunosuppressive therapy was used in all patients and consisted of either azathioprine or cellcept and corticoid,cyclosporine.Results After transplantation,all patients had normal functions pancreas and kidney grafts and stopped exogenous insulin immediately.One case died of multiple organ failure with normal pancreas graft function because of acute renal rejection.Other four cases complicated with peripancreatic abscess,acute pancreatitis,duodenal fistula and hematuria respectively and were cured after medical and surgical intervention.Two of these patients have been surviving 4 years 9 months and 3 years 8 months respectively.Conclusion SPK has the definite treatment value in the treatment of uremic diabetic patients.The bladder drainage of pancreatic juice has significant advantages over other methods.The key to promote the grafts and patients survival lies in the intensive care and preventing the medical and surgical complications.