胰岛素体循环回流和胰液肠引流式胰肾联合移植手术技巧及围术期处理

Surgical and perioperative management techniques for simultaneous pancreas-kidney transplantation with insulin systemic circulation reflux and enteric drainage

目的总结胰岛素体循环回流和胰液肠引流式胰肾联合移植的手术技巧与围术期处理经验,以降低手术风险和并发症发生率,提高移植器官的长期存活率。方法回顾性总结分析2003-2010年解放军309医院全军器官移植中心收治的5例1型糖尿病并发糖尿病肾病引发尿毒症行胰岛素体循环回流和胰液肠引流式胰肾联合移植患者的临床资料、手术技术和手术相关并发症情况。结果 5例手术均获成功。3例受者移植胰腺和肾脏顺利恢复正常,摆脱了胰岛素和降糖药物以及透析治疗;2例受者发生移植肾功能延迟恢复,其中1例因感染和多器官衰竭于围术期死亡,另1例胰动脉分支出血而手术切除供胰,移植肾功能后期恢复正常。患者摆脱胰岛素治疗时间平均为15d,肌酐恢复正常的平均时间为10d,随访时间12～96个月(截至2011年7月),移植物均存活。结论胰岛素体循环回流和胰液肠引流式胰肾联合移植是胰腺移植优先选择的术式,手术技巧和围术期的有效处置是减少乃至杜绝术后并发症及改善移植物存活的关键。

Objective The present paper aims to summarize the surgical and perioperative management techniques for simultaneous pancreas-kidney transplantation（SPKT） with insulin systemic circulation reflux and enteric drainage to reduce surgical risks and complications and improve the long-term survival of transplanted organs.Methods The present paper retrospectively analyzes the clinical data,surgical techniques,and prevention of surgery-related complications from five cases that received SPKT with insulin systemic circulation reflux and enteric drainage.These five patients suffered from Type 1 diabetes mellitus and diabetic nephropathy resulting in uremia.They were admitted to the Organ Transplant Center of the 309th Hospital of PLA from 2003 to 2010.Results Of the five successful SPKT cases,three patients had normally functioning graft pancreas and kidneys and were able to stop their insulin and hypoglycemic drug medications and dialysis.Two cases had delayed kidney graft functions.One suffered perioperative death due to infection and multiple organ failure,and the other received graft pancreas resection due to a leaky gut caused by donor duodenal segment necrosis.The graft kidney,however,retained normal function.The insulin medication was stopped after an average time of 15 days,and blood creatinine returned to its normal level after 10 days.The graft survival was checked after 12 months to 96 months（by July of 2011）,and the graft procedure was found to be successful.Conclusions SPKT with insulin systemic circulation reflux and enteric drainage is the preferred surgical technique for pancreas transplantation.Enhanced surgical skills and effective perioperative management can help reduce,and even eliminate,postoperative complications and improve graft survival.