胰、肾联合移植六例报告

Simultaneous pancreas kidney transplantation: a report of 6 cases

目的 探讨胰、肾联合移植治疗糖尿病合并糖尿病肾病的疗效。方法 回顾分析近期施行的 6例胰、肾联合移植手术的方法、疗效及并发症的防治。结果 6例患者分别于移植胰腺恢复血液循环后 2 3h、第 9d、17h、19h、第 5d及 1.5h停用外源性胰岛素 ,移植肾功能于术后第 2～ 4d恢复正常 ;术后并发症有排斥反应和血尿 ,其中 1例术后 5d发生加速性排斥反应 ,抗排斥治疗无效 ,于术后 11d切除移植胰、肾 ,其余 5例均痊愈出院。结论 胰、肾联合移植是治疗胰岛素依赖型糖尿病及达到胰岛素依赖期的非胰岛素依赖型糖尿病合并糖尿病肾病的有效方法 ;加强围手术期管理是术后减少各种并发症。

Objective To discuss the therapeutic effect of simultaneous pancreas kidney transplantation (SPK) for diabetes mellitus (DM) with diabetes nephropathy (DN). Methods The operative procedures, therapeutic effects and prevention and treatment of complications of 6 cases of SPK were retrospectively studied.Results Exogeneous insulin was withdrawn in the 6 cases at 23rd?h, 9th day, 17th?h, 19th?h, 5th day, 1.5 ?h after graft infusion respectively. Kidney function was normal within 2 to 4 days. Acute rejection and hematuria were complications for these 6 cases. Accelerate rejection appeared in one case on the 5th postoperative day, and anti rejection therapy had no effect and grafts were removed on the 11th day. The remaining 5 patients were discharged with normal pancreas and kidneys grafts function in 3 4 weeks. Conclusions SPK is the most effective therapy for diabetes with DN. SPK is also an effective treatment for insulin dependent type II diabetes mellitus with DN. Donor grafts perfusion in situ, rapid procurement, perioperative management are effective methods to prevent complications and to improve the therapeutic effects.