胰肾联合移植的外科并发症分析

Analysis of Surgical Complications after Simultaneous Pancreatic-Kidney Transplantation

目的:总结分析胰肾一期联合移植(SPK)外科并发症的发生情况、原因和处理方式。方法:12例Ⅰ型糖尿病合并尿毒症患者施行了SPK,最初2例应用胰液膀胱引流(BD)术式,另10例为改进的胰液空肠引流(ED)术式。术后早期采用他克莫司(FK506)/环孢素A(CsA)加霉酚酸酯(MMF)、皮质激素、抗淋巴细胞球蛋白(ALG)或抗CD25单抗四联诱导治疗,以后改为三联维持。抗凝治疗使用肝素和低分子右旋糖酐。结果:12例手术均获成功,术后移植胰、移植肾功能恢复良好,停用了外源性胰岛素。外科近期并发症:腹腔感染3例,切口感染2例,分别经引流、换药后二期愈合;肾周血肿2例,经手术探查、清理后好转,多与抗凝剂短期应用过量有关。远期并发症:2例BD术式患者长期存在化学性膀胱炎,其中1例发生2次反流性移植物胰腺炎,经保守治疗后好转。所有病例术后均未发生吻合口漏和移植物血管血栓形成等严重并发症。结论:外科并发症的综合防治是SPK成功的关键之一。

Objective: To analyse the surgical complications after simultaneous pancreatic-kidney transplantation (SPK). Methods: SPK was performed in 12 patients from Jan. 2000 to July 2003. All the patients suffered from insulin-dependent diabetes mellitus (IDDM) with uremia. Bladder drainage(BD) of pancreas allograft exocrine secretion was used in the first 2 cases and enteric drainage (ED) in the other 10 patients. Quadruple immunosuppressive regimes consisted of tacrolimus/cyclosporine, mycophenolate mofetil (MMF), steroid and antibodies induction which included antilymphocyte globulin (ALG) or anti-CD25 monoclonal antibody. Fraxiparine and dextran 40 were used as anticoagulant agents. Results: SPK was successfully applied to all patients without serious surgical complications such as graft thrombosis and pancreatic fistula. The patients achieved immediate kidney allograft function recovery and euglycemia. Early surgical complications included peritoneal infection(3/12), wound infection(2/12) and bleeding(2/12). Persistent hemauria was observed in the initial 2 patients with BD and two episodes of reflux graft pancreatitis were seen in one of them. Conclusions: Effective prevention and treatment of surgical complications play key roles in the success of SPK.