肝胰十二指肠器官簇移植五例治疗分析

Analysis on treatment outcomes in five patients with combined en bloc liver and pancreas transplantation

目的总结肝胰十二指肠器官簇移植术后并发症发生和器官功能恢复情况。方法对5例终末期肝病合并2型糖尿病患者进行肝胰十二指肠器官簇移植．术中保留受体胰和全消化道．行单纯肝切除术后，予以肝胰十二指肠器官簇移植。结果5例患者术程均顺利，手术时间9。16h，术中出血1600～3000ml。术后1例出现肺部感染；1例出现移植物抗宿主病（GVHD）并肺部感染；1例出现急性肾功能衰竭。5例患者均未出现肠瘘、吻合口瘘、胆道并发症、急慢性排斥反应及胰腺炎。5例患者丙氨酸转氨酶、天冬氨酸转氨酶及总胆红素等肝功能指标在术后1周趋于正常水平：C肽、血糖水平在1。2周达到正常范围。术后经2～23个月的随访，除1例因GVHD死亡外，其余4例患者肝功能均维持正常．无需外援性胰岛素即可维持血糖稳定。结论肝胰十二指肠器官簇移植在技术上具有可行性，是一种治疗多器官病变的有效方法。

Objective To summarize the treatment outcomes after combined en bloc liver and pancreas transplantation. Methods Five patients with end-stage liver disease and type 2 diabetes mellitus received combined en bloc liver and pancreas transplantation after hepatectomy. Results Five operations were performed successfully. The operative time ranged from 9 to 16 hours and blood loss from 1600 to 3000 ml. Postoperatively, one patients developed pulmonary infection, one died of graftversus-host disease （GVHD）, and one experienced acute renal failure. No intestinal fistula, anastomotic leakage, biliary complications, chronic and acute rejection and pancreatitis were seen. Liver function index including alanine aminotransferase, aspartate aminotransferase and total bilirubin returned to normal levels a week after surgery, while levels of C peptide and blood glucose resumed within 1 to 2 weeks. Apart from 1 case died of GVHD, the other 4 maintained normal liver function during the follow up ranging from 2 to 23 months and no insulin was required for the diabetes. Conclusion Combined en bloc liver and pancreas transplantation is technically feasible and an effective treatment for multi-organ diseases.