胰、肾联合移植术治疗糖尿病合并尿毒症三例

Simultaneous kidney-pancreaticoduodenal transplantation for treatment of diabetes mellitus with uremia: a report of 3 cases

目的 总结胰、肾联合移植术治疗糖尿病合并尿毒症的临床体会。方法 对 3例糖尿病合并尿毒症、周围神经病变及视网膜病变患者施行不同术式的胰、肾联合移植术 ,其中 1例为胰液膀胱引流术式 ,另 2例为胰液空肠引流术式。 3例免疫抑制治疗均采用环孢素A、霉酚酸酯及泼尼松 ,其中 2例术后早期应用单克隆抗体。结果 3例患者术后均停用胰岛素 ,血糖、C 肽以及尿素氮、肌酐均恢复正常 ;2例下肢神经传导速度及视力在术后 3个月后有不同程度的改善 ,现已存活 1 6个月、1 0个月 ,另 1例因肝功能衰竭 ,于术后 2个月死亡。结论 胰、肾联合移植术是治疗糖尿病合并尿毒症的有效手段 。

Objective To investigate the surgical techniques and perioperative management of simultaneous kidney pancreaticoduodenal transplantation (SKPT) for treatment of diabetes mellitus with uremia. Method SKPT was performed with different drainages of exocrine secretions for treatment of diabetes mellitus with uremia, peripheral neuritis and retinopathy in 3 cases. One case underwent SKPT with bladder drainage of exocrine,other 2 cases did SKPT with enteric drainage.All patients were treated with CsA+MMF+Pre as immunosuppressive treatment,two of them treated early with OKT3 postoperatively. Results Levels of blood glucose,C peptide,BUN and Cr in the 3 patients returned to the normal ranges after operation. Nerve conduction velocity of lower limbs and visual acuity were improved to some extent 3 months after operation. Two patients now survived for 16 months and 10 months with good function of grafts respectively. Conclusion SKPT is an effective therapy for diabetes mellitus with uremia and can ameliorate other diabetic complications.