胰肾联合移植术后外科并发症的临床分析

Retrospective analysis of surgical complications after pancreas-kidney transplantation

目的分析胰肾联合移植术后外科并发症发生情况、手术治疗及结果。方法统计2000年1月至2（111年12月施行的胰。肾联合移植术60例，根据术后是否发生外科并发症将受者分为并发症组及无并发症组，分析手术治疗的原因，评估再次手术对受者及移植物存活率的影响。结果术后1年内，受者死亡原因主要为肺部感染（3例）、心脑血管意外（2例）、消化道出血（1例）。感染及心脑血管意外是导致受者术后早期死亡的主要原因（5／6）。56例胰腺手术成功，术后（14±8）d完全停用胰岛素，外科并发症导致移植胰腺切除4例。15例移植肾功能恢复延迟，术后接受透析的时间为（33±12）d，其余受者肾功能均在术后2～7d恢复正常，带移植物功能死亡是移植肾丢失的主要原因（3／6）。外科并发症发生率为25％（15／60）。外科并发症主要包括：出血、切口感染、移植胰腺血管栓塞及移植胰胰腺炎，外科并发症降低了术后1年受者及移植胰腺的存活率，而对肾脏的存活率无明显影响。结论胰肾联合移植术后外科并发症发生率高，明显降低了受者和移植胰存活率，是影响术后早期受者和移植胰存活的主要因素。

Objective To retrospectively analyze the surgical complications, treatments and prognosis of combined pancreas kidney transplantation. Method Sixty cases of combined pancreas kidney transplantation were performed in Tongji Hospital from January 2000 to December 2011, and divided into reoperation group fRO） and non-reoperation group （NRO） according to whether the patients received reoperation. We analyzed donor and recipient characteristics, rate of relaparotomies, risk factors, as well as patient and graft survivals. Result Six patients died within 1 year after transplantation duo to infection （n = 3）, cardio/cerebrovascular （CCV） events （n = 2） and gastrointestinal bleeding （n = l）. CCV events and infection were the leading causes of early death （5/6）. Fifty-six patients achieved euglycemia, and no further insulin treatment was given in 14 ± 8 days post-transplantation. Graft pancreatectomy was performed on 6. 7% （4 patients）. The causes of graft loss were as follows： bleeding, severe graft pancreatitis, pancreas graft thrombosis. Fifteen patients experienced delayed graft function （the median duration was 33 ± 12 days）, and the remaining patients displayed immediate graft function. Death with a functioning graft was the principal cause for renal failure （3/6）. Conclusion Surgical complications and the necessity for relaparotomy were associated with important morbidity and significantly reduced pancreas graft survival.