胰肾联合移植治疗糖尿病合并糖尿病肾病(附13例报告)

Treatment of diabetes complicated with diabetic nephropathy by pancreas-kidney transplantation:a report of 13 cases

目的 探讨胰肾联合移植治疗糖尿病合并糖尿病肾病的疗效。方法 1999年 9月至2 0 0 2年 1月 ,我院施行了 13例胰肾联合移植手术 ,包括 6例 1型糖尿病及 7例 2型糖尿病病人 ,胰岛素用量为 0 5～ 1 5IU/ (kg·d) ,13例病人均合并糖尿病肾病 ,及心衰、高血压、视网膜病变、周围神经病变等糖尿病慢性并发症 ,并行透析治疗。 13例手术均采用体循环 膀胱内引流式。结果 6例 1型糖尿病病人于胰腺通血后 1 5～ 2 3h后停用外源性胰岛素 ,7例 2型糖尿病病人于术后第 5～ 9天停用外源性胰岛素。 13例病人均于术后第 2～ 4天移植肾功能恢复正常。术后出现排斥反应、血尿、感染并发症 ,其中 1例术后 5d发生加速性排斥反应 ,抗排斥治疗无效 ,术后 11d切除移植胰肾。其余均痊愈出院 ,定期随访 ,移植物功能良好 ,糖尿病慢性并发症得到缓解。结论 胰肾联合移植是治疗糖尿病合并糖尿病肾病的最有效方法。达到胰岛素依赖期的 2型糖尿病也是胰腺移植的适应证之一。供胰肾原位灌注、快速整块切取、以预防为主、加强围手术期管理是减少各种并发症 ,取得良好疗效的有效措施。

Objective To investigate the efficacy of pancreas-kidney transplantation (PKT) in treatment of diabetes complicated with diabetic nephropathy. Methods Thirteen patients received PKT in our hospital from September 1999 to January 2002. Of the patients, 6 were with type 1 diabetes and 7 with type 2 diabetes. All the patients suffered from renal failure and other secondary complications of diabetes. The transplantation was performed with standard approach using drainage of exocrine secretion into the bladder and diversion of venous outflow into the systemic circulation. Results No primary nonfunction of grafts occurred in all the patients. Insulin independence occurred within 1.5 to 23 h after pancreatic revasularization in the patients with type 1 diabetes and insulin could be withdrawn within 5 to 9 d after the transplantation in those with type 2 diabetes. Hematuria, acute rejection and infection were common postoperative complications. Except for one patient in whom the grafts were removed on postoperative day 11 due to accelerating rejection, other patients survived with functioning pancreas-kidney grafts regardless of the type of diabetes. Conclusions PKT is the most effective method for treatment of diabetes complicated with diabetic nephropathy. Type 2 diabetes is also one of the indications for pancreatic transplantation. Graft procurement and preservation, proper surgical technique and perioperative management are important to prevent complications and achieve good results.