摘要
目的 总结门静脉和肠道引流式胰肾联合移植的初步经验。方法 2 0 0 1年 6月～2 0 0 3年 6月共施行胰肾联合移植 5例 ,其中胰腺引流 2例采用体静脉 肠道引流 (SED) ,3例采用门静脉 肠道引流 (PED)。免疫抑制剂早期采用激素 +霉酚酸酯 (MMF) +FK5 0 6 +赛尼哌或舒莱四联诱导治疗 ,以后改为三联维持。结果 5例患者移植胰、肾功能术后 1～ 7d恢复正常 ,停用胰岛素。术后未发生消化道瘘和血栓形成等手术技术相关的并发症 ,1例SED患者发生移植肾急性排斥反应 ,经激素冲击治疗后缓解。术后SED和PED各有 1例患者因发生FK5 0 6中毒 ,最终死于败血症 ,死亡时移植胰腺功能正常。余 3例经 8、18、32个月随访 ,移植胰、肾功能良好 ,无远期并发症。结论 PED术式和SED术式在技术上安全可行 ,均无远期并发症 ,而PED术式在生理和免疫学方面更具优越性 。
Objective To summarize the initial experience of simultaneous pancreas kidney transplantation (SPK) with portal venous and enteric drainage. Methods Between Jane 2001 and Jane 2003, SPK were performed in 5 patients. Systemic venous enteric drainage (SED) was used in the first 2 patients and portal venous enteric drainage (PED) in the last 3 cases. All patient were immunosuppressed with quadruple therapy, which included anti CD25 mAb(Zenapax/Simulect) induction therapy, FK506, mycophenolate mofetil (MMF), and prednisone baseline therapy. The complications were analyzed. Results Serum glucose and renal function of the 5 cases were normal and no further insulin was needed within 7 days post operation. No technique complications such as duodenal fistula and thrombosis were observed, One episode of acute rejection of kidney allograft occurred in one patient with SED, and resolved with a bolus corticosteroids. One case with SED and one with PED were died of sepsis and FK506 toxicity 4 weeks after transplantation. The death occurred with functioning pancreas graft. No latter complications were observed in the 3 survived patients with excellent graft functions. Conclusions Both methods of SED and PED can be performed successfully and with no latter complications. But with its potential physiologic and immunologic advantages, PED might be a standard procedure for SPK.
出处
《中华外科杂志》
CAS
CSCD
北大核心
2004年第15期940-943,共4页
Chinese Journal of Surgery
关键词
器官移植
胰腺
肾
门静脉
引流
Organ transplantation
Pancreas
Kidney
Portal vern
Drainage
