胰肾联合移植治疗糖尿病终末期肾病11例临床分析

Simultaneous pancreas-kidney transplantation in the treatment of 11 cases of diabetes with end-stage renal disease

目的:探讨胰肾联合移植(SPK)治疗糖尿病合并终末期肾病的临床效果。方法:回顾性分析2016年11月至2019年3月11例糖尿病合并终末期肾病患者行SPK的临床资料,总结手术疗效以及并发症情况。结果:所有患者均接受随访,资料统计截至2019年12月1日,随访观察9~37月,人、肾、胰腺存活率分别为100%、100%、91%。11例患者术后1月血肌酐(101±28)μmol/L;末次复查血肌酐(96±24)μmol/L,糖化血红蛋白为(5.6±0.5)%。至资料统计截止时间,10例患者移植肾功能正常,1例患者新发移植肾肾病(血肌酐71~202μmol/L)。术后并发胰腺血栓形成2例,其中1例经肠系膜下静脉自脾静脉中取出血栓,胰腺功能恢复;另1例行移植胰腺切除。胰腺门静脉扭转1例,胰腺排斥反应1例,胰周脓肿1例,消化道出血1例,切口愈合不良5例。9例患者术后空腹、餐后血糖均正常,1例患者午餐后血糖稍高,口服二甲双胍血糖控制可。结论:SPK治疗糖尿病合并终末期肾病疗效确切,但围手术期并发症发生率较高,积极防治围手术期并发症可有效提高手术成功率。

Objective:To explore the clinical effect of simultaneous pancreas-kidney transplantation(SPK)in the treatment of diabetes with end-stage renal disease.Methods:The clinical data of 11 diabetic patients with end-stage renal disease who underwent SPK from November 2016 to March 2019 was retrospectively analyzed,and the curative effect and complications were summarized.Results:All patients were followed up.The data statistics were as of December 1,2019,follow-up observation from 9 to 37 months,and the survival rates of human,kidney and pancreas were 100%,100%and 91%,respectively.In 11 patients,serum creatinine was 101±28μmol/L in the first month after operation,the serum creatinine was 96±24μmol/L at the last review,and the glycosylated hemoglobin was(5.6±0.5)%.By the cut-off time of data statistics,10 patients had normal transplanted kidney function,and 1 patient had new transplanted kidney disease(serum creatinine 71 to 202μmol/L).Postoperative complications of pancreatic thrombosis occurred in 2 cases,of which 1 case underwent thrombus removal from the splenic vein via the inferior mesenteric vein,and the pancreatic function was recovered,the other case underwent pancreatic allograft resection.1 case of pancreatic portal vein torsion,1 case of pancreatic rejection,1 case of peripancreatic abscess,1 case of gastrointestinal bleeding,and 5 cases of poor incision healing.The fasting and postprandial blood glucose of 9 patients were normal after operation,and the blood glucose of 1 patient was slightly higher after lunch,and the blood glucose was controlled by oral metformin.Conclusions:SPK is effective in the treatment of diabetes and end-stage renal disease,but the incidence of perioperative complications is high.Active prevention and treatment of complications during perioperative period can effectively improve the success rate of surgery.