摘要
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。
Objective To studty 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 pancreas- kidney 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 panereatitis 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.
出处
《中华器官移植杂志》
CAS
CSCD
北大核心
2014年第8期496-500,共5页
Chinese Journal of Organ Transplantation
基金
国家高技术研究发展计划（863计划）项目（2012AA021010）
关键词
胰腺移植
胃十二指肠动脉
血管重建
外科并发症
Pancreas transplantation
Gastroduodenal artery
Vessel reconstruction
Surgical complication
