CAJ | 학술논문

目的总结胰肾联合移植中胃十二指肠动脉重建的经验,分析胃十二指肠动脉重建对术后外科并发症的影响.方法 2000年1月至2013年8月施行68例胰腺移植,其中65例胰肾同期移植及3例肾移植后胰腺移植.60例采用联合切取法获取供者肝胰肾,肝总动脉末端和胃十二指肠动脉起始段分配给肝脏,胰腺移植前常规重建胃十二指肠动脉;8例联合切取胰肾,保留胃十二指肠动脉.结果 8例胃十二指肠动脉完好,无需重建.1例因动脉吻合张力过大未行胃十二指肠动脉重建.59例重建胃十二指肠动脉,2例重建失败.65例恢复胃十二指肠动脉血液供应.术后15例(22.1％)发生19 次外科并发症,再次手术的原因为出血(8.8％)、移植胰血栓形成(2.9％)、移植胰坏死性胰腺炎(1.5％)、感染(10.3％).5例因外科并发症切除移植胰,原因为移植胰血栓形成(2例)、十二指肠吻合口出血(2例)及坏死性胰腺炎(1例).63例停用胰岛素,65例移植肾功能恢复良好.结论胃十二指肠动脉重建可保证移植胰腺和十二指肠节段的良好血液供应,可能有助于降低胰腺移植后外科并发症发生率及手术失败率.
목적 총결이신연합이식중위십이지장동맥중건적경험,분석위십이지장동맥중건대술후외과병발증적영향.방법 2000년1월지2013년8월시행68례이선이식,기중65례이신동기이식급3례신이식후이선이식.60례채용연합절취법획취공자간이신,간총동맥말단화위십이지장동맥기시단분배급간장,이선이식전상규중건위십이지장동맥;8례연합절취이신,보류위십이지장동맥.결과 8례위십이지장동맥완호,무수중건.1례인동맥문합장력과대미행위십이지장동맥중건.59례중건위십이지장동맥,2례중건실패.65례회복위십이지장동맥혈액공응.술후15례(22.1％)발생19 차외과병발증,재차수술적원인위출혈(8.8％)、이식이혈전형성(2.9％)、이식이배사성이선염(1.5％)、감염(10.3％).5례인외과병발증절제이식이,원인위이식이혈전형성(2례)、십이지장문합구출혈(2례)급배사성이선염(1례).63례정용이도소,65례이식신공능회복량호.결론 위십이지장동맥중건가보증이식이선화십이지장절단적량호혈액공응,가능유조우강저이선이식후외과병발증발생솔급수술실패솔.
Objective To study the procedure of gastroduodenal artery (GDA) reconstruction in combined pancreas-kidney transplantation (CPKT) and to evaluate the impact of this technique on the surgical complications of the pancreas allograft.Method Between January 2000 and August 2013,68 diabetic patients underwent pancreas transplantation:65 transplantations of simultaneous pancreaskidney and 3 transplantations of pancreas after kidney transplantation.Among 68 whole pancreas grafts,8 came from pancreas-kidney harvesting without necessitating GDA reconstruction.In the rest 60 cases,the distal common hepatic artery and the proximal GDA were divided to liver graft,leaving the aortic patch carrying the celiac trunk and superior mesenteric artery for the pancreas.The GDA reconstruction was routinely employed except one.The GDA was mostly anastomosed end-to-end with the common hepatic artery or left gastric artery,with or without interposing a donor mesentery artery.Result The GDA was successfully reconstructed in 57 cases.GDA reconstruction was abandoned in 2 cases duce to thrombosis and high tension between GDA and common hepatic artery.The GDA supply was restored in 65 of 68 pancreas allografts.Fifteen patients (22.1％) underwent one or more relaparotomies.The causes for relaparotomy were:graft thrombosis in 2 cases (2.9％),bleeding in 6 cases (8.8％),severe pancreatitis in one case (1.5％),and infection in 7 cases (10.3％).Graft pancreatectomy was performed in 33.3％ (5 patients).The causes of graft loss were:graft thrombosis in 2 cases (2.9％),bleeding in 2 cases (2.9％),and severe pancreatitis in one case (1.5％).Mortality rate after relaparotomy was 4.4％ (three patients).Conclusion The reconstruction of GDA may ensure a better blood supply to the pancreas and duodenum and furthermore decrease the surgical complication and technical failure in CPKT.