肝、胰、肾一期联合移植一例临床分析

目的 研究肝、胰、十二指肠及。肾脏一期联合移植治疗肝炎后肝硬化并发尿毒症伴胰岛素依赖型糖尿病的外科技术和临床效果。方法 2005年1月对1例肝炎后肝硬化并发尿毒症伴胰岛素依赖型糖尿病的患者进行了肝、胰、十二指肠及。肾一期联合移植,采用原位背驮式方法进行肝移植,移植胰的外分泌采用空肠内引流,移植肾脏置于左髂窝。应用抗CD25单克隆抗体诱导免疫抑制,抗胸腺球蛋白（ATG）＋他克莫司（FK506）＋霉酚酸酯（MMF）＋激素的四联免疫抑制。结果 移植肝脏及胰腺功能10d内恢复,。肾脏功能延迟恢复,于术后第16天因肾皮质血流突然下降,切除移植肾脏,进行第二次肾移植,肾功能3d恢复正常。无外科并发症,未发生排斥反应,患者目前移植肝、胰、。肾功能均正常,一般情况良好。结论 原位背驮式及胰液空肠引流式肝、胰、十二指肠及肾同期联合移植的技术安全,是治疗肝硬化并发尿毒症伴胰岛素依赖型糖尿病的较好术式。

A case report of simultaneous liver, pancreas-duodenum, and kidney transplantation in a patient with post-hepatitic cirrhosis combined with uremia and insulin-dependent diabetes related to chronic pancreatitis

Objective To study the effect of triple organ transplantation(liver,kidney,and pancreas)in patient of end-stage liver disease with renal failure and diabetes,and to explore the optimal surgical procedure.Methods Simultaneous piggyback orthotopic heterotopic liver,pancreas-duodenum, and kidney transplantation was performed on a 43-year-old male patient with exocrine pancreatic insufficiency and insulin-dependent diabetes related to chronic pancreatitis(CP)who developed hepatic and renal failure. The pancreatic exocrine secretions were drained enterically to the jejunum.Prednisone,tarcrolimus, mycophenolate mofetil,and ATG were used as immunosuppression therapy.Results Good liver and pancreas allograft function recovery was achieved within 7 days after the operation.And the recovery of renal allograft function was delayed.The renal allograft was removed because of break-down of renal blood flow 16 days after the transplantation.A new renal transplantation was performed at the same position.The second kidney graft recovered its normal function 3 days later.Up to the writing of this paper no acute rejection of organs and such complications as pancreatitis,thrombosis,and localized infection occurred.The patient became insulin independent with normal liver and renal function.Conclusion Simultaneous piggyback orthgotopic heterotopic liver,pancreas-duodenum,and kidney transplantation can be a good method for the patients with exocrine pancreatic insufficiency and insulin-dependent diabetes combined with hepatic and renal failure.