实用器官移植电子杂志
實用器官移植電子雜誌
실용기관이식전자잡지
Practical Journal of Organ Transplantation (Electronic Version)
2014年
6期
350-355
,共6页
宋文利%郑建明%赵杰%冯钢%莫春柏%沈中阳
宋文利%鄭建明%趙傑%馮鋼%莫春柏%瀋中暘
송문리%정건명%조걸%풍강%막춘백%침중양
胰肾联合移植%下腔静脉%糖尿病%尿毒症%髂动脉
胰腎聯閤移植%下腔靜脈%糖尿病%尿毒癥%髂動脈
이신연합이식%하강정맥%당뇨병%뇨독증%가동맥
Simultaneous pancreas-kidney%Inferior vena cava%Diabetes%Uremia%Iliac artery
目的探讨利用供者髂动脉搭桥的腔静脉回流式胰肾联合移植术的手术操作及临床效果。方法天津市第一中心医院器官移植中心于2009年1月至2011年12月为35例糖尿病合并终末期肾病的患者施行了利用供者髂动脉搭桥的腔静脉回流式胰肾联合移植术，移植胰腺和肾脏分别经供体髂外、髂内动脉吻合，经供者髂总动脉吻合至受体髂外动脉，胰腺静脉回流至受者下腔静脉，供体十二指肠与受体回肠侧侧吻合，观察患者的一般结果、术后外科并发症、远期并发症及随访35～58个月结果。结果所有患者的移植胰腺及肾脏均于术后1周内恢复正常。术后住院时间为10～33天，平均22天，住监护室时间为1～4天，平均2.4天。患者中采用他克莫司（FK506）+吗替麦考酚酯（MMF）+泼尼松（Pred）联合免疫方案33例；采用环孢素A+MMF+Pred联合免疫方案2例。所有患者中发生移植肾功能延迟恢复3例，排斥反应发生率为0。患者出院时平均血清肌酐为78μmol/L，空腹血糖为4.4 mmol/L，糖化血红蛋白为4.3%。术后并发症：供体十二指肠与受者回肠吻合口出血2例，伤口愈合不良4例，术后腹腔感染4例，肺感染5例，泌尿系统感染1例，巨细胞病毒（CMV）感染2例，FK506的脱髓鞘病变1例。3例患者出现需手术干预的外科并发症；其中1例粘连性肠梗阻，予手术松解后治愈；1例胰腺广泛血栓形成，予手术切除移植胰腺后出现腹腔感染、切口裂开，予手术清理、缝合后治愈；1例移植肾破裂，切除，胰腺移植后5个月行二次肾移植术；术后再次手术率为8.6%。术后随访32～58个月，术后6个月平均血清肌酐为82μmol/L，空腹血糖为4.8 mmol/L，糖化血红蛋白为4.5%。1例患者术后4个月死于肺感染，其余患者全部存活，患者、胰腺、移植肾的1年存活率分别为97.1%、94.2%、94.2%。结论利用供者髂动脉搭桥的腔静脉回流式胰肾联合移植术手术操作简单，创伤较小，拓宽了受者范围；为患者保留一侧髂血管，为今后再次肾移植创造了条件；术后需外科干预的并发症明显降低。
目的探討利用供者髂動脈搭橋的腔靜脈迴流式胰腎聯閤移植術的手術操作及臨床效果。方法天津市第一中心醫院器官移植中心于2009年1月至2011年12月為35例糖尿病閤併終末期腎病的患者施行瞭利用供者髂動脈搭橋的腔靜脈迴流式胰腎聯閤移植術，移植胰腺和腎髒分彆經供體髂外、髂內動脈吻閤，經供者髂總動脈吻閤至受體髂外動脈，胰腺靜脈迴流至受者下腔靜脈，供體十二指腸與受體迴腸側側吻閤，觀察患者的一般結果、術後外科併髮癥、遠期併髮癥及隨訪35～58箇月結果。結果所有患者的移植胰腺及腎髒均于術後1週內恢複正常。術後住院時間為10～33天，平均22天，住鑑護室時間為1～4天，平均2.4天。患者中採用他剋莫司（FK506）+嗎替麥攷酚酯（MMF）+潑尼鬆（Pred）聯閤免疫方案33例；採用環孢素A+MMF+Pred聯閤免疫方案2例。所有患者中髮生移植腎功能延遲恢複3例，排斥反應髮生率為0。患者齣院時平均血清肌酐為78μmol/L，空腹血糖為4.4 mmol/L，糖化血紅蛋白為4.3%。術後併髮癥：供體十二指腸與受者迴腸吻閤口齣血2例，傷口愈閤不良4例，術後腹腔感染4例，肺感染5例，泌尿繫統感染1例，巨細胞病毒（CMV）感染2例，FK506的脫髓鞘病變1例。3例患者齣現需手術榦預的外科併髮癥；其中1例粘連性腸梗阻，予手術鬆解後治愈；1例胰腺廣汎血栓形成，予手術切除移植胰腺後齣現腹腔感染、切口裂開，予手術清理、縫閤後治愈；1例移植腎破裂，切除，胰腺移植後5箇月行二次腎移植術；術後再次手術率為8.6%。術後隨訪32～58箇月，術後6箇月平均血清肌酐為82μmol/L，空腹血糖為4.8 mmol/L，糖化血紅蛋白為4.5%。1例患者術後4箇月死于肺感染，其餘患者全部存活，患者、胰腺、移植腎的1年存活率分彆為97.1%、94.2%、94.2%。結論利用供者髂動脈搭橋的腔靜脈迴流式胰腎聯閤移植術手術操作簡單，創傷較小，拓寬瞭受者範圍；為患者保留一側髂血管，為今後再次腎移植創造瞭條件；術後需外科榦預的併髮癥明顯降低。
목적탐토이용공자가동맥탑교적강정맥회류식이신연합이식술적수술조작급림상효과。방법천진시제일중심의원기관이식중심우2009년1월지2011년12월위35례당뇨병합병종말기신병적환자시행료이용공자가동맥탑교적강정맥회류식이신연합이식술，이식이선화신장분별경공체가외、가내동맥문합，경공자가총동맥문합지수체가외동맥，이선정맥회류지수자하강정맥，공체십이지장여수체회장측측문합，관찰환자적일반결과、술후외과병발증、원기병발증급수방35～58개월결과。결과소유환자적이식이선급신장균우술후1주내회복정상。술후주원시간위10～33천，평균22천，주감호실시간위1～4천，평균2.4천。환자중채용타극막사（FK506）+마체맥고분지（MMF）+발니송（Pred）연합면역방안33례；채용배포소A+MMF+Pred연합면역방안2례。소유환자중발생이식신공능연지회복3례，배척반응발생솔위0。환자출원시평균혈청기항위78μmol/L，공복혈당위4.4 mmol/L，당화혈홍단백위4.3%。술후병발증：공체십이지장여수자회장문합구출혈2례，상구유합불량4례，술후복강감염4례，폐감염5례，비뇨계통감염1례，거세포병독（CMV）감염2례，FK506적탈수초병변1례。3례환자출현수수술간예적외과병발증；기중1례점련성장경조，여수술송해후치유；1례이선엄범혈전형성，여수술절제이식이선후출현복강감염、절구렬개，여수술청리、봉합후치유；1례이식신파렬，절제，이선이식후5개월행이차신이식술；술후재차수술솔위8.6%。술후수방32～58개월，술후6개월평균혈청기항위82μmol/L，공복혈당위4.8 mmol/L，당화혈홍단백위4.5%。1례환자술후4개월사우폐감염，기여환자전부존활，환자、이선、이식신적1년존활솔분별위97.1%、94.2%、94.2%。결론이용공자가동맥탑교적강정맥회류식이신연합이식술수술조작간단，창상교소，탁관료수자범위；위환자보류일측가혈관，위금후재차신이식창조료조건；술후수외과간예적병발증명현강저。
Objective To discuss the procedure and the clinical effects of a vena cava drainage bypass through the donor's iliac artery during a simultaneous pancreas-kidney(SPK)transplantation. Methods In Organ Transplantation Center of Tianjin First Center Hospital,between January 2009 and December 2011,we performed a SPK transplantation with a vena cava drainage bypass through the donor's iliac artery for 35 patients with diabetes mellitus that was complicated with end-stage renal disease. The pancreatic allograft artery and renal allograft artery were anastomosed with the donor's external iliac artery and internal iliac artery,respectively. Then, the donors'common iliac artery was sewn to the recipient's external iliac artery. The donor's pancreatic vein was <br> anastomosed with the recipient's inferior vena cava for drainage. The donor's duodenum was side-to-side anastomosed to the recipients' ileum. The patients' general results,surgical complications,and long-term complications was observed, and follow-up period was 35-58 months. Results All of the renal and pancreatic allografts were restored to their normal functions within 1 week after operation. The length of hospitalization ranged from 10 to 33 days(average 22 days). The length of intensive care unit stay ranged from 1 to 4 days(average 2.4 days). 33 patients were administered with combined immunosuppression therapy with tacrolimus(FK506) +mycophenolatemofetil(MMF)+prednisone(Pred). 2 patients wereprescribed combined immunosuppression therapy with cyclosporin A + MMF + Pred. In all patients,there were three cases of DGF,and none of rejection. At the time of discharge,the patients' average serum creatinine level was 78μmol/L,with average fasting glucose level of 4.4 mmol/L,and their average glycated hemoglobin percentage of 4.3%. The following post-operative complications were observed:two cases of anastomotic bleeding between the donor duodenum and the recipient ileum,four cases of poor wound healing,four cases of post-operative abdominal infections,five cases of pulmonary infections,one case of urinary tract infection,two cases of cytomegalovirus infections,and one case of FK506 related demyelinating disease. Three cases underwent re-operations. One case underwent adhesion lysis for adhesive intestinal obstruction. One case underwent pancreatectomy for diffuse pancreatic thrombosis and suffered post-operative abdominal infection and wound dehiscence which were healed with debridement suture operation. One case underwent nephrectomy for renal graft rupture and received second kidney transplantation 5 months later. The re-operation rate was 8.6%. All patients were followed up for 32-58 months. Six months after the surgery,the patients' average serum creatinine level was 82μmol/L,with average fasting glucose level of 4.8 mmol/L,and mean glycated hemoglobin percentage of 4.5%. All of the patients survived except one case died of pulmonary infection 4 months after operation. One year survival rates of recipients,pancreatic allograft,renal allograft were 97.1%,94.2%,94.2%,respectively. Conclusion SPK transplantation with a vena cava drainage bypass through the donor's iliac artery is a simple procedure that leads to less severe trauma than traditional methods and is also appropriate for a wider range of recipients. Moreover,one side of the iliac artery is unaffected,which is useful for the second kidney transplantation in a recipient,if this procedure is later needed. The number of post-operative complications that needed surgical interventions were also significantly reduced compared to those associated with traditional methods.
