The Current State of Pancreas-kidney Transplantation in China:The Indications,Surgical Techniques and Outcome

It is currently estimated that 50 million Chinese have diabetic mellitus （DM） with more than 90% of these being afflicted with type 2 DM. Concomitantly, the socio-economic improvements in China are supporting the adoption of pancreas-kidney transplantations as a treatment option for these patients. Recipient candidate pool has yet to be expanded and the final effect to be improved in clinical practice. To date, more than 250 pancreas-kidney transplants have been performed on patients with type 1 and type 2 DM. To improve the outcome, a new surgical technique that involves anastomosis of the graft duodenum to recipient jejunum side-to-side but not Roux-en-Y, has been devised for enteric drainage. Furthermore, the systemic venous drainage （SVD） has been used as the method of choice for endocrine secretions. Graft and recipient long-term survival in China was similar to that in America and Europe. Three-year survival rate of pancreas and kidney grafts was 92.2% and 90.2%, respectively, in our center. No difference in survival and graft function between type 1 and type 2 DM recipients was noted. It is concluded that pancreas-kidney transplantation is an effective way for the treatment of type 1 DM and some type 2 DM complicated with uremia.

Establishment of simultaneous pancreas and kidney transplantation (SPK) model with cuff technique and portal venous drainage in rats

To establish a simultaneous pancreas and kidney transplantation （SPK） model in the rat. Methods： SD rats served as donors and recipients. The donor portal vein and the recipient superior mesenteric vein were anastomosed and the donor renal veins and recipient renal veins were anastomosed by cuff method. Arterial reconstruction was carried out by end to side anastomosis of the donor abdominal aorta to the recipient abdominal aorta. Enteric drainage was performed by side to side anastomosis between donors＇ duodenum and recipients＇ jejunum. The donor ureter -bladder valve was anastomosed to the bladder of recipients. Results： Out of 30 cases of SPK transplantation, 24 had normal serum glucose and serum creatinine after operation. The successful rate was 80 %. Conclusion： This model of SPK in rats is stable and reliable, which could be applied for further scientific research.

Simultaneous pancreas-kidney transplantation with modified enteric drainage of exocrine pancreatic secretion

BACKGROUND: As a valid therapeutic option for patients with type 1 diabetes mellitus (IDDM) and secondary dia- betic nephropathy, simultaneous pancreas-kidney trans- plantation (SPK) remains more undeveloped than other solid organ transplantations due to the restrictions of surgi- cal techniques especially the modes of exocrine pancreatic secretion. The aim of this paper was to summarize our sin- gle-center experience in SPK with modified enteric drai- nage (ED). METHODS: From June 2000 to July 2003, 10 patients with IDDM associated with uremia received SPK. The pancrea- tic allograft exocrine secretion was drained into the proxi- mal jejunum via a side-to-side duodenojejunostomy with- out Roux-en-Y anastomosis. Quadruple immunosuppres- sive regimen consisted of induction of tacrolimus (TAC) / cyclosporine (CsA), mycophenolate mofetil (MMF), ste- roids and antibodies, which included antilymphocyte glo- bulin (ALG) or anti-CD25 monoclonal antibody. RESULTS: ED-SPK without Roux-en-Y anastomosis was successful in all 10 patients without serious complications such as pancreatitis, graft thrombosis and pancreatic fistu- la. The patients regained immediate kidney allograft func- tion and euglycemia with insulin-independence. Four pa- tients survived over one year. Episodes of acute rejection were observed in 4 patients, 3 of whom showed reversion after treatment of OKT3 or insulin. Early postoperative complications included peritoneal infection ( 2 patients ), wound infection (2) and renal hematoma (1). CONCLUSION: ED-SPK without Roux-en-Y anastomosis is safe and preferable to the patients with IDDM associated with uremia.

EN BLOC TRANSPLATION OF KIDNEY AND WHOLE PANCREAS WITH A SEGMENT OF DUODENUM IN RATS

For meeting the clinic needs in simultaneous pancreas and kidney transplantation (SPK), we success-fully establish a syngeneic SPK transplatation model in Lewis rats. The results indicate that this model isfeasible with a 82. 6% successful rate of operation and a 69. 6% survival rate in the first postoperativeweek. In long-term survived rats, the blood supplies are well established, function of the grafts (pancreasand kidney) maintains normal. This model is suitable for theoretical reserach in SPK transplantation for itsreasonable physiology with pancreatic juice drained into intestine and reduced postoperative complications inurinary tract and carbohydrate metabolism.

Establishment of a pig model of combined pancreas-kidney transplantation

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DIFFERENCE OF REJECTION IN SINGLE VERSUS COMBINED PANCREAS AND KIDNEY TRANSPLANTATION IN RATS

Objective.To investigate the difference of rejection in single versus combined pancreas and kidney transplantation in rats. Methods.Allograft models including simultaneous pancreas and kidney(SPK)transplant and pancreas or kidney transplant alone were established in SD-Wistar rats, rejections of pancreas and kidney in different models were compared morphologically and functionally. Results.Mean survival time(MST)of pancreas was significantly prolonged in SPK than in pancreas transplant alone(PTA)(115 days vs. 92 days, P<005). Incidence of interstitial pancreatic rejection at grade Ⅱ and grade Ⅲ was much obvious in PTA than in SPK(429% vs. 125% at grade Ⅱ and 286% vs 63% at grade Ⅲ , P<005). No significant difference was found in MST between SPK and kidney transplant alone(KTA). Administration of cyclosporine A prolonged the MST of pancreas and kidney, without altering the tendency stated above. Conclusions.In SPK, the function of pancreas is protected by kidney hence the severity of rejection is reduced, whereas the function of kidney is not protected by pancreas. It suggests that different organs differ in immunoallergization and immunoregulation, and immune response tend to attack organs with greater immunoactivity, those organs with minor one could be protected. Cyclosporine A is effective on prolonging the MST of pancreas and kidney.

Parvovirus B19 status in liver,kidney and pancreas transplant candidates:A single center experience

BACKGROUND Parvovirus B19(B19V)is associated with a wide range of clinical manifestations.The major presentation is erythema infectiosum.However,a persistent infection may cause pure red cell aplasia and chronic anemia in immunocompromized patients.The B19V seroprevalence varies with age and geographical location.AIM To determine the B19V serological status and DNAemia in kidney,liver,and pancreas transplant candidates.METHODS Patients who underwent kidney,liver,or simultaneous kidney and pancreas/liver transplantation between January 2021 and May 2022 were included in the study.The serum samples were collected before transplantation.For detection of B19V DNA,a LightMix Kit B19V EC(TIB MOLBIOL,Berlin,Germany)was used.B19V IgM and IgG antibodies were detected using a commercial ELISA test(Euroimmun,Lübeck,Germany).RESULTS One hundred and thirty-one transplant candidates were included in the study,71.0%male,with an average age of 53.27 years±12.71 years.There were 68.7%liver,27.5%kidney,3.0%simultaneous pancreas/kidney transplant(SPKT),and 0.8%simultaneous liver/kidney transplant recipients.No patients had detectable B19V DNA.B19V IgG seroprevalence was 77.1%.No acute or recent infections were detected(IgM antibodies).There was no difference in the mean age of seronegative and seropositive patients(51.8 years±12.9 years vs 53.7 years±12.7 years,t=-0.603;P=0.548).Although seropositivity was lower in patients aged less than 30 years(66.6%)compared to the patients aged 30-59 years and>60 years(80.4%and 78.1%,respectively),this difference was not significant.In addition,there was no difference in seropositivity between male and female transplant candidates,76.3%and 78.9%(χ^(2)=0.104;P=0.748).The seroprevalence did not differ among organ recipients,with 77.8%,80.6%,and 50.0%for liver,kidney,and SPKT,respectively,(χ^(2)=5.297;P=0.151).No significant difference was found in the seroprevalence in kidney transplant patients according to dialysis modality.Seroprevalence was 71.1%in hemodialysis patients,and 100%in peritoneal dialysis patients(χ^(2)=0.799;P=0.372).CONCLUSION The B19V seroprevalence is expectedly high among kidney,liver,and pancreas transplant candidates,but there are still 22.9%of seronegative individuals who remain at risk for primary disease and severe manifestations.Further research should elucidate the necessity of B19V screening in peri-transplant management.

A retrospective monocenter review of simultaneous pancreaskidney transplantation with bladder drainage in China

Background Simultaneous pancreas-kidney transplantation （SPKT） frees the diabetic patient with end-stage nephropathy from dialysis and daily insulin injections.Herein,we review consecutive cases of SPKT with bladder drainage performed at our institution over an 8-year period.Methods The study population included 21 patients （16 males and 5 females） who underwent SPKT between September 2001 and September 2009.Seven patients had type-1 diabetes and 14 had type-2 diabetes.Nineteen patients were on dialysis at the time of transplantation.Donation after cardiac death donors were selected for SPKT.The mean human leukocyte antigen match was 2 （range 0-4）.SPKT was always performed using bladder drainage and vascular anastomoses to the systemic circulation.Immunosuppressive treatment consisted of anti-lymphocyte globulin induction followed by tacrolimus,mycophenolate mofetil,and prednisone.Results The mean hospital stay was 45.43 days.After a mean follow-up of 39.4 months,survival rates for patient,kidney,and pancreas were 76.2%,76.2%,and 66.7% at 1 year;76.2%,59.3%,and 55.6% at 5 years;and 57.1%,39.5%,and 41.7% at 8 years,respectively.Major complications included anastomotic leaks,reflux pancreatitis,and rejection.Six patients died from septic shock （n=3）,duodenal stump leak （1）,cardiac arrest （1）,or renal failure （1）.Eight kidney grafts were lost due to acute rejection （n=2）,chronic rejection （3）,and death with a functioning graft （3）.Pancreatic graft failure （9） was caused by thrombosis （n=1）,rejection （2）,duodenal stump leak （1）,and death with a functioning graft （5）.Concluslons SPKT is a valid therapeutic option for uremic diabetics although few hospitals in China can undertake SPKT.

Mortality assessment for pancreas transplants in the United States over the decade 2008-2018

BACKGROUND Pancreas transplant is the only treatment that establishes normal glucose levels for patients diagnosed with diabetes.However,since 2005,no comprehensive analysis has compared survival outcomes of:(1)Simultaneous pancreas-kidney(SPK)transplant;(2)Pancreas after kidney(PAK)transplant;and(3)Pancreas transplant alone(PTA)to waitlist survival.AIM To explore the outcomes of pancreas transplants in the United States during the decade 2008-2018.METHODS Our study utilized the United Network for Organ Sharing Standard Transplant Analysis and Research file.Pre-and post-transplant recipient and waitlist characteristics and the most recent recipient transplant and mortality status were used.We included all patients with type I diabetes listed for pancreas or kidneypancreas transplant between May 31,2008 and May 31,2018.Patients were grouped into one of three transplant types:SPK,PAK,or PTA.RESULTS The adjusted Cox proportional hazards models comparing survival between transplanted and non-transplanted patients in each transplant type group showed that patients who underwent an SPK transplant exhibited a significantly reduced hazard of mortality[hazard ratio(HR)=0.21,95%confidence intervals(CI):0.19-0.25]compared to those not transplanted.Neither PAK transplanted patients(HR=1.68,95%CI:0.99-2.87)nor PTA patients(HR=1.01,95%CI:0.53-1.95)experienced significantly different hazards of mortality compared to patients who did not receive a transplant.CONCLUSION When assessing each of the three transplant types,only SPK transplant offered a survival advantage compared to patients on the waiting list.PKA and PTA transplanted patients demonstrated no significant differences compared to patients who did not receive a transplant.

MRI and magnetic resonance angiography in evaluating simultaneous pancreas-kidney transplantation

OBJECTIVE: To evaluate the value of magnetic resonance imaging (MRI) and three dimensional (3D) contrast magnetic resonance angiography (MRA) in the diagnosis of complications of simultaneous pancreas-kidney transplantation (SPKT), as confirmed by biopsy and digital subtraction angiography (DSA). METHODS: Five MR examinations of five patients were performed within 28 days to 2 years after surgery on GE 1.5T MR system. Imaging techniques included axial and sagittal chemical fat-suppressed T1-weighted image (T1WI) and T2-weighted image (T2WI), additional contrast axial or saggital chemical fat-suppressed T1WI were obtained after 3D contrast MRA for calculating the mean percentage of the parenchymal enhancement (MPPE) of the pancreas and kidney. 3D contrast MRA was performed with Smartprep technique. MRA data were analyzed with maximum intensity projection (MIP) and multi-planner reformat (MPR). RESULTS: In five cases of transplant pancreases, MRI found two normal pancreas grafts, one case of acute rejection, one case of chronic rejection with 70% fibrosis and one case of late pancreatitis. In five transplant kidneys, MRI detected four normal kidney grafts and one case of acute rejection with infarction. MPPE could distinguish infarction from other complications. 3D contrast MRA could display vascular complications of SPKT, such as stenosis or occlusion, aneurysm formation of transplanted vessels and narrowing at the site of anastomosis, as confirmed by DSA. CONCLUSION: With combined application of MRI and 3D contrast MRA, complications of SPKT can be clearly identified.

Early rejection and pathological changes in combined pancreaticoduodenal and kidney allotransplantation in pigs

Objective: To study the markers of early rejection and pathological changes in simultaneous pancreati- coduodenal and kidney transplantation (SPKT). Methods: Thirty hybrid pigs were used as donors and recipients. A renoportal end-to-end anastomosis be- tween the left renal vein and the distal end of the portal vein was performed. Two vascular end-to-side anastomoses between the donor portal vein and recip- ient inferior vena cava, and between the donor aortic segment including the celiac and superior mesenteric, and left renal arteries and recipient abdominal aorta were carried out. Pancreas exocrine secretion drain- age was established with duodenocystostomy. Ureter- ostomosis of the graft was performed. Urine amylase level, fasting blood glucose and urine volumes of kid- ney allograft were monitored, and pathological chan- ges of graft were observed. Results: Of 15 recipients, 2 died of disturbance of in- ternal environment and anastomotic bleeding, re- spectively. Satisfactory results were obtained in the remaining 13 recipients. The changes of urine amyl- ase concentration were prior to those of fasting blood glucose and urine volumes of kidney allograft. The degree of rejection of the kidney allograft was more severe than that of the pancreas and duodenum al- lograft. Conclusions: Urine amylase is the early marker of a- cute rejection in SPKT with bladder drainage of pan- creatic exocrine secretion. The pathological change of kidney allograft is most significant in SPKT.

Machine perfusion in abdominal organ transplantation: Current use in the Netherlands

Scarcity of donor organs and the increment in patients awaiting a transplant increased the use of organs from expanded criteria donors or donation after circulatory death.Due to the suboptimal outcomes of these donor organs,there is an increased interest in better preservation methods,such as ex vivo machine perfusion or abdominal regional perfusion to improve outcomes.This state-ofthe-art review aims to discuss the available types of perfusion techniques,its potential benefits and the available evidence in kidney,liver and pancreas transplantation.Additionally,translational steps from animal models towards clinical studies will be described,as well as its application to clinical practice,with the focus on the Netherlands.Despite the lack of evidence from randomized controlled trials,currently available data suggest especially beneficial effects of normothermic regional perfusion on biliary complications and ischemic cholangiopathy after liver transplantation.For ex vivo machine perfusion in kidney transplantation,hypothermic machine perfusion has proven to be beneficial over static cold storage in a randomized controlled trial,while normothermic machine perfusion is currently under investigation.For ex vivo machine perfusion in liver transplantation,normothermic machine perfusion has proven to reduce discard rates and early allograft dysfunction.In response to clinical studies,hypothermic machine perfusion for deceased donor kidneys has already been implemented as standard of care in the Netherlands.

What's new in clinical solid organ transplantation by 2013

Innovative and exciting advances in the clinical science in solid organ transplantation continuously realize as the results of studies, clinical trials, international conferences, consensus conferences, new technologies and discoveries. This review will address to the full spectrum of news in transplantation, that verified by 2013. The key areas covered are the transplantation activity, with particular regards to the donors, the news for solid organs such as kidney, pancreas, liver, heart and lung, the news in immunosuppressive therapies, the news in the field of tolerance and some of the main complications following transplantation as infections and cancers. The period of time covered by the study starts from the international meetings held in 2012, whose results were published in 2013, up to the 2013 meetings, conferences and consensus published in the first months of 2014. In particular for every organ, the trends in numbers and survival have been reviewed as well as the most relevant problems such as organ preservation, ischemia reperfusion injuries, and rejections with particular regards to the antibody mediated rejection that involves all solid organs. The new drugs and strategies applied in organ transplantation have been divided into new way of using old drugs or strategies and drugs new not yet on the market, but on phase Ⅰto Ⅲ of clinical studies and trials.

细胞凋亡在大鼠胰腺移植急性排斥反应中的作用

目的探讨细胞凋亡和相关因子Fas、FasL、bcl-2和bax在大鼠胰腺移植急性排斥反应中的作用,评价十二指肠黏膜活检在胰腺移植中诊断排斥反应的价值。方法选SD和Wistar大鼠行全胰十二指肠移植,实验分同基因胰腺移植组和异基因胰腺移植组。于移植术后第3、5及7d分批处死受体,取移植胰腺和十二指肠标本用HE染色和原位末端脱氧核糖核苷酸转移酶标记技术(TUNEL)检测移植物。免疫组化法检测移植后胰腺和十二指肠Fas、FasL、bcl-2和bax的表达。结果异基因胰腺移植组胰腺和十二指肠病理评分相同者占61.1%(11/18);评分不同者占38.9%(7/18),其中胰腺评分较高者6例,十二指肠黏膜评分较高者仅1例。异基因胰腺移植组胰腺和十二指肠病理学评分和细胞凋亡指数均明显高于同基因胰腺移植组(P<0.05,P<0.01)。胰腺和十二指肠细胞凋亡指数与急性排斥反应的病理学评分成正相关(r=0.965,P<0.01;r=0.942,P<0.01)。随着术后时间延长,排斥反应分级上升,细胞凋亡增加,FasL表达升高,在异基因移植组bcl-2表达下降,而Fas和bax表达无明显变化。结论细胞凋亡与移植胰腺急性排斥反应的严重程度呈正相关,细胞凋亡指数可作为判断移植物损伤程度的指标。FasL和bcl-2与胰腺移植急性排斥及组织损伤密切相关。十二指肠黏膜活检有助于判断有无胰腺急性排斥反应发生。

同期原位肝-异位胰十二指肠联合移植治疗终末期肝病合并糖尿病

目的评价肝胰联合移植治疗终末期肝病合并糖尿病的效果,探讨其最佳术式。方法对1例慢性乙型病毒性肝炎、肝硬化、原发性肝细胞癌合并胰岛素依赖型糖尿病患者施行同期原位肝-异位胰十二指肠联合移植,术后早期采用皮质激素、霉酚酸酯、他克莫司、舒莱四联用药,监测肝功能、血淀粉酶、脂肪酶、血糖、胰岛素C肽变化及免疫指标。结果患者术后5 d后停用胰岛素,移植肝功能恢复正常,没有发生移植胰胰腺炎、血管栓赛、胰漏、局部感染等并发症。结论1、终末期肝病合并糖尿病,特别是需要胰岛素治疗的糖尿病,是肝胰联合移植的适应证;2、同期原位肝-异位胰十二指肠联合移植优于其他肝胰联合移植术式,可以作为肝胰联合移植的常规首选术式。

多器官联合移植的免疫抑制治疗

目的 探讨多器官联合移植术后的免疫抑制治疗方法。方法 对 2例 1型糖尿病并发尿毒症患者施行改良式胰液肠腔引流式胰、十二指肠及肾一期联合移植 ;1例高龄酒精性肝硬化终末期并发慢性肾功能不全尿毒症患者和 1例肝硬化肝功能衰竭肝移植术后移植肝、肾功能衰竭患者施行一期肝肾联合移植 ;1例慢性乙型病毒性肝炎、肝硬化、原发性肝细胞肝癌合并胰岛素依赖型糖尿病患者施行同期原位肝 -异位胰十二指肠联合移植术。术后采用抗胸腺淋巴细胞球蛋白 (ATG)、抗CD2 5单克隆抗体诱导 ,他克莫司 (FK5 0 6 )、霉酚酸酯 (MMF)及激素三联维持治疗。结果 5例患者术后移植物功能恢复良好 ,其中 1例胰肾联合移植患者术后出现 1次FK5 0 6导致的肾中毒 ,1例肝肾联合移植患者和肝胰联合移植患者术后发生 1次急性排斥反应 ,分别经调整药物剂量和抗排斥治疗后逆转。目前 5例患者全部存活 ,移植物功能正常。结论 多器官联合移植术后采用ATG、抗CD2 5单克隆抗体诱导 ,FK5 0 6、MMF及激素三联维持治疗是安全有效的 ,用药期间应监测移植物功能和FK5 0 6的血药浓度 ,防止排斥反应和FK5 0 6中毒。

上腹部器官簇移植治疗多脏器恶性肿瘤手术方式探讨

上腹部器官簇移植受者5例,其中男性4例,女性1例;胰腺癌肝转移3例,肝癌胰腺及腹腔淋巴结转移2例.5例患者分别于2004年5月至2005年4月接受上腹部器官簇移植治疗,切除脏器包括全胃、肝脏、胰腺、脾脏、十二指肠及部分空肠, 移植器官簇包括肝脏、胰腺、十二指肠及部分空肠.所有患者均于术后4～6 h清醒,8～14 h撤除呼吸机;术后第3～7 d从SICU转回普通病房开始康复治疗.AST、ALT及TB等肝功能指标在术后1周趋于正常水平;C-肽、血淀粉酶、血清胰岛素水平在1～2周内达到正常范围.目前,除1例患者出现肿瘤复发外,其余病例一般情况良好.肝胰十二指肠器官簇移植具有肿瘤根治彻底、器官功能替代全面的特点,是上腹部多脏器恶性肿瘤的有效治疗方法.

上腹部器官簇联合肾脏移植治疗多器官病变的临床分析

目的研究腹部器官簇(肝、胰、十二指肠)及肾脏一期联合移植治疗肝炎后肝硬化并发尿毒症伴胰岛素依赖型糖尿病的外科技术和临床效果。方法 2016年7月对1例肝炎后肝硬化并发尿毒症伴胰岛素依赖型糖尿病的患者进行了肝、胰、十二指肠及肾脏联合移植,受者切除患肝后,原位植入包括肝脏、胰腺、部分十二指肠的器官簇,肝脏移植采用经典原位肝移植术式,受体门静脉与供肝门静脉采用端侧吻合,器官簇的肝总动脉与肠系膜上动脉采用髂血管成型成统一开口后与受体肝总动脉吻合。胆道和胰腺外引流采用供者十二指肠与受者上段空肠Roux-en-Y侧侧吻合方式。肾移植采用传统异位肾移植术,器官簇与肾脏来源于同一个供者。免疫抑制方案采用术中巴利昔单抗诱导,术后他克莫司(Tac)+吗替麦考酚酯(MMF)+激素联合应用预防排斥反应。结果患者于术后2周,肝肾功能指标恢复至正常范围,术后3周完全脱离胰岛素治疗,并且血糖水平维持正常。结论腹部器官簇移植是治疗终末期肝病合并胰岛素依赖的2型糖尿病的有效手段。

原位肝胰十二指肠联合移植:附2例报告

目的探讨肝胰十二指肠联合移植的适应证和治疗效果。方法总结分析本中心近两年实施的肝胰十二指肠联合移植2例,1例为酒精性肝硬化伴2型糖尿病,1例为乙肝肝硬化伴2型糖尿病肾病。2例患者均采用原位整块的肝脏、十二指肠、胰腺联合移植。供者器官切取和修整简单,移植时依次吻合肝上、肝下下腔静脉;供者肠系膜上静脉与受者肠系膜上静脉吻合;供者腹腔干动脉与受者肝总动脉吻合。术后采用巴利昔单抗诱导治疗;采用他克莫司(FK506)+霉酚酸酯(MMF)+泼尼松(Pred)三联免疫抑制治疗。结果患者1实施肝胰十二指肠联合移植,术后出现肠瘘,未发生弥漫性腹膜炎和严重感染,经充分引流后,肠瘘逐渐愈合。患者2实施肝胰十二指肠移植联合肾移植,术后出现胰腺周围积液和切口愈合不良,予以充分引流和换药处理后痊愈;2例患者术后移植肝和移植胰腺功能恢复正常,完全脱离胰岛素治疗。患者1由于术后1年7个月发生急性排斥反应,应用甲泼尼龙冲击治疗,出现胃肠穿孔继发腹膜炎而死亡;患者2术后6个月出现血丙氨酸转氨酶(ALT)升至150 U/L,转换为低剂量他克莫司联合西罗莫司治疗,患者肝功能改善,ALT维持在80 U/L。患者存活至今,移植物功能良好。结论对于终末期肝病伴有血糖难以控制的糖尿病患者实施肝胰十二指肠联合移植治疗,可以取得良好的治疗效果。

肝胰十二指肠器官簇移植外科技术

2004年9月1例原发性肝癌合并胰头转移的患者在我院接受肝胰十二指肠器官簇移植,整块切除全肝、胆囊、十二指肠、胰腺、脾脏、胃大部和部分上段空肠,进行了血管和消化道重建。移植后胰腺功能正常,未应用胰岛素维持。术后第4d肠道功能恢复,术后1周肝功能恢复正常;术后16d时因腹腔内出血行剖腹探查血肿清除术,同时对感染伤口进行减张缝合,愈合良好;术后2月时出现不全性肠梗阻症状,保守治疗后好转。患者目前已存活5个月,肝脏和胰腺功能均正常,痊愈出院。肝胰十二指肠器官簇移植术的成功为上腹部晚期恶性肿瘤患者提供了延长生命的机会,同时为晚期肝病伴有胰腺功能不良患者的彻底治愈探索出新的手术方式。