胰液肠腔引流式胰十二指肠及肾一期联合移植一例报告

Simultaneous kidney-pancreaticoduodenal transplantation with enteric drainage of exocrine pancreatic secretions: report of one case

目的 总结胰液肠腔引流式胰肾联合移植的经验,探讨联合移植用药量,减少并发症。方法 对1例Ⅰ型糖尿病并发尿毒症患者施行胰液肠腔引流式一期联合移植,术后早期应用他克莫司（FK506）、霉酚酸酯（MMF）、皮质激素和抗胸腺细胞球蛋白（ATG）进行免疫抑制治疗。监测胰腺、肾的功能恢复情况。结果 术后第3d,受者血肌酐、尿素氮恢复正常,术后第4d出现FK506中毒,致尿量减少,经调整FK506用量及进行血液透析过渡无尿期,术后第10d,肾功能恢复正常;术后第5d停用胰岛素,移植胰内外分泌功能正常,术后第20d并发消化道出血,使用善得定及施他宁治疗痊愈。无其它外科并发症。结论 （1）胰液肠腔引流术式优于胰液膀胱引流术式;（2）胰液肠腔引流式胰、十二指肠及肾联合移植是治疗胰岛素依赖型糖尿病并发尿毒症的有效方法;（3）优质的供者及良好的配型可减少并发症的发生。

To summarize the clinical technique and experience of simultaneous kidney-pancreatic transplantation (SKPT) with enteric drainage (ED). Methods One patient with insulin-dependent diabetes mellitus/end-stage renal disease underwent SKPT with enteric drainage of exocrine secretions. The patient received an immunosuppression therapy including antithymocyte globulin (ATG), prednisone, FK506 and Mycophenolate-Mofetil (MMF). Results The patient became insulin-independent after he had been treated by small dose insulin for 10 days. Until now all the grafts of the patient no other complications occurred. Conclusions (1) ED-SKPT is more effective than BD-SKPT ( simultaneous kidney-pancreatic transplantation with bladder drainage). (2)ED-SKPT is an effective method for treating type Ⅰ diabetes mellitus with uremia. (3)Finer allograft and nicer HLA-typing can decrease complications.