摘要
目的总结并分析12例糖尿病合并终末期肾病患者接受胰肾同期联合移植（SPK）手术的近期疗效及经验。方法为合并终末期肾病的7例1型糖尿病患者和5例2型糖尿病患者施行胰肾同期联合移植手术，其中采用胰液膀胱引流（BD）术式10例，采用改进的胰液空肠引流（ED）术式2例。术中以抗淋巴细胞球蛋白或抗CD25单克隆抗体诱导治疗，早期采用他克莫司＋吗替麦考酚酯及皮质激素三联免疫抑制方案。结果10例手术成功，术后随访2～60个月，受者存活良好。受者术后半年和1年存活率均为91．6％（11／12），移植胰腺术后半年和1年存活率均为83．3％（10／12），移植肾术后半年和1年存活率均为91．6％（11／12）。1例受者出现坏死性胰腺炎，切除胰腺，6个月后再次移植胰腺获得成功。1例受者术后出现移植肾功能恢复延迟，后出现膀胱黏膜出血，3次介入栓塞治疗，后并发肺部感染死亡，死亡时移植胰、肾功能正常。术后（14．2±5．1）d空腹血糖恢复正常，（9．5±4．2）d停用胰岛素，（10．4±6．5）d血肌酐恢复正常。住院时间（21．4±7．3）d，术后发生手术相关并发症有移植胰切口感染、淋巴漏各1例；其他并发症有泌尿系感染1例，他克莫司中毒1例，1例发生经活检证实的移植肾急性排斥反应。11例受者痊愈出院。结论胰肾同期联合移植是治疗糖尿病合并终末期肾病的有效方法。公民逝世后器官捐献（DCD）供者器官功能保护体系的应用，精细和个体化的围手术期治疗方案，有可能提高胰肾联合移植手术的近期疗效。
Objective To summarize the short-term results of simultaneous pancreas-kidney transplantation （SPK） at a single center in China. Methods SPK was performed on 12 consecutive patients from Jan. 2010 to July 2014. All patients had long-standing insulin-dependent diabetes mellitus （IDDM） and subsequent renal failure. Bladder drainage （BD） of exocrine secretion was used in the 10 cases and enteric drainage （ED） in 2 patients. The patients were treated with quadruple therapy, which included ATG or anti-CD25 monoclonal antibody induction therapy, prednisone, tacrolimus and mycophenolat-mofetil （MMF）. Results The SPK was performed successfully in 10 cases. One patient accepted re-pancreas transplantation due to necrotizing pancreatitis. One patient suffered hemorrhage of bladder, accepted 3 times of embolization therapy and died due to lung infection. Ten patients achieved excellent renal function and euglycemia, and no further insulin treatment was given in 9. 5± 4. 2 days posttransplant. Fasting plasma glucose returned to normal in 14. 2 ± 5.1 days. Serum creatinine returned to normal in 10. 4 ± 6. 5 days. The mean hospital stay was 21.4 ±7. 3 days. One biopsy-proven renal rejection episodes occurred in 14 days postoperation. Main complications included wound infections on the side of pancreatic graft, lymphorrhagia, tacrolimus toxicity and urinary tract infection. Conclusion SPK is an effective therapy of ESRD. Donated graft protection system foundation, refinement and individualized treatment posttransplantion may be the key factors for successful SPK.
出处
《中华器官移植杂志》
CAS
CSCD
2016年第11期641-646,共6页
Chinese Journal of Organ Transplantation
基金
广西科学技术开发与研究项目（桂科攻14124003-8）
广西壮族自治区卫生与计生委员会课题（Z2016520）
关键词
肾
胰腺
移植
治疗结果
Kidney
Pancreas
Transplantation
Treatment outcome
