胰肾联合移植治疗Ⅰ型糖尿病合并终末期肾病

Simultaneous pancreas-kidney transplantation for the treatment of type I diabetes with end-stage renal disease

目的 探讨胰肾联合移植治疗Ⅰ型糖尿病合并终末期肾病的临床效果。 方法 8例Ⅰ型糖尿病合并终末期肾病的患者接受胰肾联合移植 ,平均年龄 43 46岁 ,2例合并视网膜病变 ,双目失明 ,病史 2～ 2 2年。胰腺移植于右髂窝 ,胰腺外分泌经膀胱引流 ,肾脏移植于左髂窝。免疫抑制方案开始四联用药 ,以后三联用药继续治疗。 结果 8例患者其中 7例术后即不需要应用胰岛素 ,空腹血糖可维持在正常范围。 1例术后应用胰岛素 40d后停用。 1例患者至今存活 1年 9个月 ,另 4例患者已存活 2个月 ;空腹血糖 4 5～ 6 2mmol/L ,血肌酐 5 3～ 10 6 μmol/L。不需控制饮食。 2例患者术后第 3周死于脑血管意外 ,1例死于胰腺血管栓塞 ,坏死性胰腺炎。 结论 胰肾联合移植是治疗Ⅰ型糖尿病合并终末期肾病的切实可行的方法。在现有条件下可获得有功能的供体胰腺。经膀胱胰腺外分泌途径引流 ,有利于监测尿淀粉酶的变化 ,帮助早期诊断排斥反应。术后应用肝素可以预防胰腺血管血栓形成。

s Objective[WT5”BZ] To demonstrate whether simultaneous pancreas kidney transplantation is practical for the treatment of Type I diabetes with end stage renal disease. [WT5”HZ]Methods[WT5”BZ] Eight cases of combined pancreas kidney transplantation were performed in our institute. The age ranged from 35 years to 48 years (average 43.46 years). All cases were diagnosed as type I diabetes with end stage nephropathy, two cases with blindness due to retinopathy. The case history ranged from 2 years to 22 years. Pancreas allograft was placed in the right iliac fossa with pancreas exocrine drainage to bladder, whereas renal allograft the in left iliac fossa. Initial immunosuppression regimen is quadruple. [WT5”HZ]Results[WT5”BZ] Seven patient could be insulin free after transplantation, with normal fasting blood glucose. One patient received insulin treatment for 40 days after operation. One patient survived 1 year and 9 months after transplantation with normal functioning pancreas allograft and kidney allograft. Four patient survived 2 months with normal allograft function. Fasting blood glucose was between 4.5 and 6.2 mmol/L; Cr was between 53 and 106 μmol/L. Diet control was not necessary. Two patient died of encephalorrhagia, and 1 pancreatic vascular thrombosis and necrotic pancreatitis. [WT5”HZ]Conclusions[WT5”BZ] Combined pancreas kidney transplantation is feasible to treat type I diabetes with end stage renopathy. Functional pancreas allograft could be procured in the present condition. Pancreatic exocrine is drained to bladder. The diagnosis of acute rejection could be made earlier by detecting urine anylase. Heparin should be added in order to prevent pancreatic thrombosis. [WT5”HZ]