胰肾联合移植治疗糖尿病肾功能衰竭五例临床分析

Simultaneous pancreas and kidney transplantation for 5 patients with diabetesplus end-stage renal disease

目的总结胰肾联合移植(SPK)围手术期及出院后随访期处理经验,降低SPK术后并发症发生,提高SPK临床效果。方法回顾性分析2017年11月至2018年10月5例因糖尿病肾功能衰竭接受SPK术受者的临床资料、围手术期及出院后随访期资料。结果5例受者供胰、供肾冷缺血时间均控制在8 h内,围手术期无外科技术性出血、肠瘘、动静脉大血栓、坏死性胰腺炎等并发症发生。1例术后原发性移植肾功能恢复延迟经血液透析后逐渐康复;2例术后因抗凝而发生移植胰腺区域腹腔内渗血,经药物促凝治疗后止血成功,但其中1例导致继发性肾功能障碍,经透析和调整免疫抑制剂剂量后逐渐恢复;1例术后因抗凝而发生消化道出血,经药物促凝治疗后停止;3例术后1周后常规移植物彩色超声检查发现移植胰腺内血管小血栓形成,经抗凝治疗后消失或稳定好转;1例移植肾周积液感染经局麻清创引流后康复;2例术后出现高钾血症经治疗后血钾恢复正常;1例术后第45天突发急性左心功能衰竭,经心肺复苏后恢复自主心率,但意识未恢复,1周后受者家属放弃治疗出院;其余4例受者术后血糖与血肌酐水平完全恢复正常且脱离外源性胰岛素使用与透析,康复出院,其中1例在术后143 d出现急性排斥反应经激素冲击治疗后缓解。随访至2019年3月20日,目前存活的4例受者空腹血糖及血肌酐水平均正常,糖尿病并发症得以缓解或改善。结论SPK是治疗糖尿病肾功能衰竭的有效手段,能使受者脱离胰岛素及维持性透析,改善糖尿病并发症,从而明显提高受者的生活质量。

Objective To reduce the perioperative complications of simultaneous pancreas and kidney transplantation (SPK) and boost the clinical efficacy by exploring its perioperative management in diabetics with end-stage renal disease. Methods Retrospective analysis was performed for the clinical data of 5 diabetics with end-stage renal disease undergoing SPK since 2017. Results The cold ischemic time of all allografts was under 8 hours. No surgical complications occurred in recipients post-transplantation. Two patients were complicated with hyperkalemia and their serum potassium levels normalized after treatment. One case of bleeding in abdominal cavity was cured conservatively. Renal functions of two patients with delayed renal function post-transplantation gradually recovered after hematodialysis. One case of peritransplant fluid collection recovered after debridement and drainage. Another case of acute left heart failure and cardiac arrest at 45 days post-transplantation resumed normal heart rhythm after rescue. However, his consciousness could not be restored and his families gave up subsequent treatments. Transplanted kidneys and pancreases of these 4 patients normalized. Follow-up was conducted until March 20, 2019. They became insulin and dialysis independent and serum creatinine and blood glucose normalized. Diabetic complications were relieved and their quality-of-life also improved significantly. Conclusions SPK is an effective treatment for diabetics with end-stage renal disease. While maintaining normal serum creatinine and blood glucose, it may liberate patients from insulin dosing and dialytic maintenance, lower diabetic complications and improve quality-of-life.