改良的胰液空肠引流式胰腺、十二指肠-肾脏一期联合移植1例报告

目的 探讨胰液空肠引流式胰、十二指肠肾脏一期联合移植的临床技术。方法 对糖尿病终末期肾病患者施行志愿者供体的一期胰、十二指肠及肾联合移植术。胰腺外分泌采用十二指肠和上段空肠直接侧侧吻合引流(不用Roux-en-Y吻合)。术前应用赛尼哌抗体诱导治疗,术后给予FK506 骁悉 泼尼松三联免疫抑制剂方案治疗。结果 术后胰、肾立即发挥功能,外源性胰岛素于术后7天停用,肾功能于术后3天恢复正常,未出现严重的外科并发症。术后35天痊愈出院,胰、肾功能良好。结论 改良的胰液空肠引流式胰腺、十二指肠一肾脏一期联合移植安全可靠,是治疗胰岛素依赖型糖尿病(IDDM)并发尿毒症的有效方法。改良术式较传统术式(采用Roux-en-Y吻合)技术简便,也可避免胰液膀胱引流术式相关的外科并发症。现代免疫抑制剂的应用和良好的配型可减少并发症的发生。

Modified simultaneous kidney-pancreatico-duodenal transplantation with enteric drainage of exocrine pancreatic secretions: a case report

Objective To evaluate the technique of modified simultaneous renal-pancreatico-duodenal transplantation (SKPT) with enteric drinage (ED). Methods Simultaneous pancreaticoduodenal and kidney transplantation of cadaver donors has been performed for one uremic patient with insulin-dependent diabetes mellitus (IDDM). The allograft exocrine secretions were drained into the proximal jejunum via a side-to-side duodenojejunostomy (non Roux-en-Y). The patient received an immunosuppression therapy including zenapax (CD25 antibody), FK506, mycophenolate mofitil (MMF), and predinisone. Results Exogenous insulin was withdrawn on the 7 th day after operation and the renal function became normal on the 3 rd day. No serious surgical complication occurred. 35 days after operation, the patient was discharged with normal pancreatic and renal function. Conclusions (1) The modified ED-SKPT without Roux-en-Y anastomosis is a safe and effective procedure for the treatment uremia accompanied by of IDDM. (2) The modified ED-SKPT (non Roux-en-Y) is simpler than traditional method (with Roux-en-Y) in surgical technique, and it has no operation related complications as seen after BD-SKPT (simultaneous kidney-pancreatico-duodenal transplantation with bladder drainage). (3) Current immunosuppressive agents and good HLA-typing may decrease complications.