CAJ | 학술논문

目的探讨保留受者胰腺的肝胰十二指肠联合移植的临床效果.方法总结分析3例保留受者胰腺的肝胰十二指肠联合移植者的病例资料.例1原发病为乙型肝炎肝硬化合并糖尿病,例2为酒精性肝硬化合并糖尿病,例3为乙型肝炎肝硬化糖尿病合并肾功能衰竭.结果 3例患者均实施了切除病肝和保留自体胰腺的肝胰十二指肠联合移植,例3同时实施了肾移植.例1术后出现轻型胰腺炎,经引流后好转出院,术后第4年开始恢复使用胰岛素,用量较术前少,目前肝功能正常.例2术后出现肠吻合口漏,经保守治疗后好转,肝胰功能正常出院,术后19个月因急性排斥反应,应用甲泼尼龙冲击治疗后,出现肠穿孔继发腹膜炎而死亡.例3术后出现胰腺炎和胰周积液,引流后好转出院,术后1年恢复使用胰岛素,用量较术前少,目前肝、肾功能正常.结论保留受者胰腺的肝胰十二指肠联合移植治疗终末期肝病合并糖尿病具有良好的临床效果,但是如何长期维持移植胰腺的内分泌功能仍需进一步研究.
목적 탐토보류수자이선적간이십이지장연합이식적림상효과.방법 총결분석3례보류수자이선적간이십이지장연합이식자적병례자료.례1원발병위을형간염간경화합병당뇨병,례2위주정성간경화합병당뇨병,례3위을형간염간경화당뇨병합병신공능쇠갈.결과 3례환자균실시료절제병간화보류자체이선적간이십이지장연합이식,례3동시실시료신이식.례1술후출현경형이선염,경인류후호전출원,술후제4년개시회복사용이도소,용량교술전소,목전간공능정상.례2술후출현장문합구루,경보수치료후호전,간이공능정상출원,술후19개월인급성배척반응,응용갑발니룡충격치료후,출현장천공계발복막염이사망.례3술후출현이선염화이주적액,인류후호전출원,술후1년회복사용이도소,용량교술전소,목전간、신공능정상.결론 보류수자이선적간이십이지장연합이식치료종말기간병합병당뇨병구유량호적림상효과,단시여하장기유지이식이선적내분비공능잉수진일보연구.
Objective To investigate the effects of treatment on end-stage liver disease and diabetes mellitus by simultaneous liver-pancreas-duodenum transplantation with the pancreas of the recipients reserved.Method Simultaneous liver-pancreas-duodenum transplantations were carried out in three patients with the pancreas of the recipients reserved.The diseases of the recipient 1,2,and 3 were alcoholic liver cirrhosis and diabetes mellitus,chronic hepatitis B liver cirrhosis and diabetes mellitus,and chronic hepatitis B liver cirrhosis and diabetes mellitus complicated with renal function failure.The recipient 3 received simultaneous renal transplantation.Result The recipient 1 suffered from pancreatitis after the operation and discharged with normal liver function and blood glucose levels,and he was treated with insulin at 4th year after the operation.Intestinal fistula occurred in the recipient 2 and drainage was done without acute peritonitis,the liver allograft was experienced an acute rejection episode treated by intravenous bolus methylpredisolone at 19th month after operation,but gastrointestinal perforation happened and the patient died of acute peritonitis.In the recipient 3,peripancreatic effusion and pancreatitis happened and were treated by drainage,and the recipient survived to now with normal liver and kidney functions,but given insulin at first year after operation.Conclusion It is effective to implement simultaneous liver-pancreas-duodenum transplantation with the pancreas of the recipients reserved on the patients with end-stage liver disease and diabetes mellitus.However,how to maintain the pancreatic endocrine function after the transplantation for a long period awaits further investigation.