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-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.     

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。     

应用现代免疫抑制剂减少胰—肾联合移植外科并发症

目的：提高胰－肾联合移植的治疗效果。　方法：对１ 例胰岛素依赖型糖尿病合并尿毒症患者施行膀胱引流式尸体胰十二指肠－肾一期联合移植术。术后采用包括抗淋巴细胞诱导的四联序贯免疫抑制方案,维持免疫抑制采用包括环孢素,强的松和骁悉的三联方案。　结果：术后第４ 天,移植肾和胰腺功能恢复良好,转为胰岛素非依赖,血肌酐、尿素氮及空腹血糖降至正常。未发生外科并发症。　结论：胰十二指肠－肾一期联合移植术是治疗胰岛素依赖型糖尿病合并尿毒症一种行之有效的手段。     

胰肾Ⅰ期联合移植术后并发症的观察

于 2 0 0 2年 3月 11日首次实施胰肾Ⅰ期联合移植 ,患者男性 ,年龄 5 3岁 ,糖尿病史 6年 ,尿毒症史 3年 ,术前行血液透析疗法 2年 ,采用全胰十二指肠肾脏的移植方式 ,胰液的外分泌予以保留并经膀胱作为胰液的引流途径。术后短期内胰肾发挥了正常的生理功能 ,停用口服降糖药及胰岛素 ,现就术后并发症的观察进行总结。1　排斥反应的观察和护理1.1　肾排斥反应观察　主要监测血清肌酐值的变化和每小时尿量 ,监测每小时尿量的变化是观察移植肾是否存活的关键 ,每小时尿量必须多于 10 0ｍｌ～ 2 0 0ｍｌ,同时监测患者的生命体证及早期自觉症状 ,…     

胰肾联合移植对糖尿病患者胰岛功能的影响

目的 了解胰肾联合移植术后糖尿病患者胰岛功能的恢复状况及对糖尿病疗效的影响。方法 检测手术前后血糖,C肽和胰高血糖素,并进行比较,术后180d时测定胰岛素释放试验和葡萄糖耐量试验。结果 术前病人的C肽水平明显低于正常,胰高血糖素高于正常,尽管使用了较大量的胰岛素,血糖仍然较高。术后第1天开始C肽分泌明显增加,几乎超过正常,胰高血糖素分泌技术前几乎减少一半,30d后降到正常;术后第7天血糖降到正常,第20天停用胰岛素,240d内血糖仍然在还范围,术后180d时检测葡萄糖耐量试验和胰岛素释放试验结果均正常。结论 胰肾联合移植既能改善1型糖尿病肾病病人的肾功能,又能通过提高胰腺β细胞的分泌功能,达到治疗糖尿病的目的。胰肾联合移植是治疗1型糖尿病晚期肾病的最佳方法。     

小型猪胰十二指肠移植模型的建立

目的：建立一种新的胰液肠内引流式小型猪全胰十二指肠移植模型。方法：采用手术切除受体胰腺,制造Ⅰ型糖尿病模型。移植物的门静脉与受体的下腔静脉吻合,移植物的腹主动脉下段与受体的肾动脉下方的腹主动脉吻合,十二指肠与受体空肠吻合。结果：20例动物移植后效果满意,存活期胰腺功能基本正常。结论：该模型方法简单易行,可作为胰腺移植研究的理想模型。     

应用胰管胆管外引流防止胰十二指肠切除术后吻合口瘘

在9例胰十二指肠切除术中应用长50cm,直径3mm的塑料管及改制成“Y”形的T型管各一根,分别置于胰管和左右肝管分叉部,经空肠远端肠壁开孔引出肠腔,行胰液胆汁体外引流,该引流技术不仅具有支撑作用,而且使胰液和胆汁分流于体外,避免胆汁激活胰酶前体,更重要的是可防止术后早期肠袢蠕动未恢复时Roux-Y肠袢扩张而增加吻合的张力,以利胰肠胆肠吻合口愈合.另外术式选择和操作技术也与吻合瘘发生率有关.该法简单易行,效果满意,是防止吻合口瘘的好方法。     

大鼠门脉回流、内引流胰十二指肠移植动物模型的建立

建立大鼠门脉回流、内引流胰十二肠移植动物模型。使该模型符合正常生理特点，采用供体门静脉同受体肠系膜上静脉在低位相吻合，形成门静脉回流；供体十二指肠同受体近端空肠相吻合。结果显示67例药物诱导糖尿病大鼠行胰十二指肠移植，46例成活超过7天，42例非禁食情况下，血糖正常，所有46例成功大鼠血胰岛素浓度正常。提示该模型符合正常生理特点。可以用来进一步研究胰十二指肠移植的免疫和生理特点。     

胰肾舒联合移植新进展

胰肾舒联合移植新进展１００８５３北京解放军总医院陈光富，李炎唐关键词胰肾联合移植，肾脏移植，胰腺移植中国图书资料分类号Ｒ６１７胰肾联合移植（ＳＰＫＴ）是目前器官移植中的新领域，首例ＳＰＫＴ是由Ｋｅｌｌｙ等人于１９６６年１２月在１例２８岁糖尿病并晚期肾...     

胰十二指肠切除术中胰胃吻合及吻合器的应用效果观察

目的探讨胰腺胃吻合术及吻合器在胰十二指肠切除术(PD)中的应用价值。方法 40例患者按照知情同意原则分为观察组(n=22)和对照组(n=18例),均采用经典PD术式行脏器游离、切除。对照组行手工胰肠、胆肠及胃肠吻合;观察组采用捆绑式胰腺胃吻合术行胰液内引流,采用吻合器行胆肠、胃肠吻合,记录两组手术时间、吻合时间,比较两组术后住院天数及并发症发生情况。结果与对照组比较,观察组手术时间及吻合时间缩短、术后住院天数减少(P<0.05),而两组术后并发症比较差异无统计学意义(P>0.05)。结论胰腺胃吻合术及吻合器在胰十二指肠切除术中应用简单、安全、易行,可明显缩短手术时间,提高手术效率,但远期疗效尚待进一步观察。     

The role of interventional radiology and imaging in pancreatic islet cell transplantation

Pancreatic islet cell transplantation (PICT) is a novel treatment for patients with insulin-dependent diabetes who have inadequate glycaemic control or hypoglycaemic unawareness, and who suffer from the microvascular/macrovascular complications of diabetes despite aggressive medical management. Islet transplantation primarily aims to improve the quality of life for type 1 diabetic patients by achieving insulin independence, preventing hypoglycaemic episodes, and reversing hypoglycaemic unawareness. The islet cells for transplantation are extracted and purified from the pancreas of brain-stem dead, heart-beating donors. They are infused into the recipient's portal vein, where they engraft into the liver to release insulin in order to restore euglycaemia. Initial strategies using surgical access to the portal vein have been superseded by percutaneous access using interventional radiology techniques, which are relatively straightforward to perform. It is important to be vigilant during the procedure in order to prevent major complications, such as haemorrhage, which can be potentially life-threatening. In this article we review the history of islet cell transplantation, present an illustrated review of our experience with islet cell transplantation by describing the role of imaging and interventional radiology, and discuss current research into imaging techniques for monitoring graft function.     

Multimodality imaging of pancreas-kidney transplants

Simultaneous pancreas-kidney transplant remains a treatment option for patients with insulin-dependent diabetes mellitus type 1, aimed at restoring normoglycemia, alleviating insulin dependency, avoiding diabetic nephropathy, and thereby improving the quality of life. Imaging remains critical in the assessment of these transplant grafts. Ultrasound with Doppler remains the primary imaging modality for establishing baseline assessment of the graft as well as for evaluating vascular, parenchymal, and perigraft complications. Noncontrast MR imaging is preferred over non-contrast CT for evaluation of parenchymal or perigraft complications in patients with decreased renal function, although contrast-enhanced CT/MR imaging may be obtained following multidisciplinary consultation in cases with high clinical and laboratory suspicion for graft dysfunction. Catheter angiography is reserved primarily for therapeutic intervention in suspected or confirmed vascular complications. An understanding of the surgical techniques and imaging appearance of a normal graft is crucial to identify potential complications and direct timely management. This article provides an overview of surgical techniques, normal imaging appearance, as well as the spectrum of imaging findings and potential complications in pancreas-kidney transplants.     

Imaging and management of complications of open surgical repair of abdominal aortic aneurysms

Open repair is still considered the reference standard for long-term repair of abdominal aortic aneurysms (AAA). In contrast to endovascular aneurysm repair (EVAR), patients with open surgical repair of AAA are not routinely followed up with imaging. Although complications following EVAR are widely recognized and routinely identified on follow-up imaging, complications also do occur following open surgical repair. With frequent use of multi-slice computed tomography (CT) angiography (CTA) in vascular patients, there is now improved recognition of the potential complications following open surgical repair. Many of these complications are increasingly being managed using endovascular techniques. The aim of this review is to illustrate a variety of potential complications that may occur following open surgical repair and to demonstrate their management using both surgical and endovascular techniques.     

Interventional radiology in chemotherapy. Percutaneous arterial route and and embolization with microspheres

The authors present their experience with interventional radiological techniques employed for chemotherapy: 205 intra-arterial chemotherapy (IAC) cycles were administered to 67 patients (lesion sites were: liver 20, pelvis 35, unknown 12). Catheters were left in place for 5 days in 89% of cases. The positions of the end of the catheter was checked by CT scan, with concomitant arterial opacification in the case of pelvic pathologies; this allowed evaluation of the tumor volume treated. Serious radiological complications of IAC included: 2 surgical thrombectomies and 2 surgical removals of broken catheters (2% complication rate for IAC). 15 embolizations with microcapsules of mitomycin were performed for 11 patients, using the technique of Kato. Venous blood samples revealed the persistence of mitomycinemia for up to four hours. three instances of pain were noted in the 24 hours following embolization. These two techniques have a low rate of serious complications; the therapeutic efficacy observed in certain cases warrants the use of these methods for cancers impossible to treat by radical procedures.     

Diversion ahead: imaging appearance of urinary diversions and reservoirs

The imaging appearance of urinary diversion is determined by the indication and type of surgical procedure performed. These patients often undergo an imaging follow-up to detect complications or recurrence. Understanding the postoperative anatomy and early detection of complications are keys to adept interpretation of radiological evaluation of urinary reservoirs. The purpose of following review is to offer a brief account of commonly used surgical techniques, relevant anatomy, and concise overview of the imaging techniques for evaluation of the urinary diversions and features of their complications.     

Complications of meniscal repair

Meniscal repair (open or arthroscopic) should be in the armamentarium of every orthopedist who performs knee surgery. The purpose of this article is to present the complications inherent in general knee arthroscopy as well as those specific to meniscal repair. Specific complications of meniscal repair discussed are (1) failure of the repair to heal, (2) neurovascular complications, (3) arthrofibrosis, and (4) infection.The authors also present techniques and recommendations to minimize these potential complications. Medial and lateral knee anatomy, with respect to standard surgical approaches for midhorn and posterior horn repairs, is discussed. Finally, the authors present their recommendations to minimize the failure-to-heal rate of meniscal repair.     

Endovascular Treatment of Acute Portal Vein Thrombosis After Liver Transplantation in a Child

Although operative techniques in hepatic transplantation have reduced the time and mortality on waiting lists, the rate of vascular complications associated with these techniques has increased. Stenosis or thrombosis of the portal vein is an infrequent complication, and if present, surgical treatment is considered the traditional management. This article describes a case of acute portal vein thrombosis after liver transplantation from a living donor to a child managed by percutaneous techniques.     

Iatrogene Langzeitschäden nach nicht-anatomischer lateraler Bandrekonstruktion am oberen Sprunggelenk

Patients with chronic anterolateral ankle instability with recurrent ankle sprains qualify for a surgical intervention. Various surgical techniques of reconstruction have been proposed in the past century and can be classified in anatomic- and non-anatomic reconstructions methods. The mid-to long-term results showed that particularly non-anatomic tenodesis-techniques lead to degenerative changes in the ankle joint,. Nowadays, consensus exists that the anatomic reconstruction for chronic lateral ankle instability should be preferred.The present article gives an overview over the three most common non-anatomic tenodesis-techniques and illustrates their most frequent complications.     

Surgical approaches to the forefoot for common sports-related pathologies: a review of the literature and cadaveric dissection

This article reviews the published literature regarding the surgical approaches to pathologies encountered within the forefoot, including arthroscopic and open techniques, and their treatment. We have demonstrated these surgical approaches with cadavers, to identify the key anatomical landmarks and safe zones for these surgical techniques, to prevent the complications associated with their treatment.     

Selective intra-arterial cytostatic injections in malignant head and neck tumors

Summary Regional intra-arterial drug administration has been advocated in order to reduce the risks of systemic complications in conjunction with systemic tumor chemotherapy. We have been using superselective angiographic techniques to administer the antitumor drug mitomycin C directly into the feeding arteries of the tumor in 15 patients with advanced malignant head and neck tumors. No complications were observed. In five patients the tumor decreased significantly in size, in four patients, tumor cell necrosis was found. A marked decrease in pain was reported by nine of the 15 patients.