同期原位肝-异位胰十二指肠联合移植治疗终末期肝病合并糖尿病

目的评价肝胰联合移植治疗终末期肝病合并糖尿病的效果,探讨其最佳术式。方法对1例慢性乙型病毒性肝炎、肝硬化、原发性肝细胞癌合并胰岛素依赖型糖尿病患者施行同期原位肝-异位胰十二指肠联合移植,术后早期采用皮质激素、霉酚酸酯、他克莫司、舒莱四联用药,监测肝功能、血淀粉酶、脂肪酶、血糖、胰岛素C肽变化及免疫指标。结果患者术后5 d后停用胰岛素,移植肝功能恢复正常,没有发生移植胰胰腺炎、血管栓赛、胰漏、局部感染等并发症。结论1、终末期肝病合并糖尿病,特别是需要胰岛素治疗的糖尿病,是肝胰联合移植的适应证;2、同期原位肝-异位胰十二指肠联合移植优于其他肝胰联合移植术式,可以作为肝胰联合移植的常规首选术式。

Simultaneous orthotopic liver and heterotopic pancreas-duodenum transplantation in a diabetic patient with end-stage liver disease

Objective To study the effect of combined transplantation of the liver and the pancreas in diabetic patients withend-stage liver disease, and explore the optimal surgical procedure. Methods Simultaneous orthotopic liver and heterotopicpancreas-duodenum transplantations were performed in a patient diagnosed as having chronic hepatitis B, hepatocirrhosis,hepatic cellular cancer, and insulin-dependent diabetes. Immunosuppression therapy utilized prednisone, tacrolimus (FK506),mycophenolate mofetil (MMF), and simulect. The function of the liver graft, serum amylase and lipase, blood glucose, andC-peptide were monitored after transplantation. Results Insulin was withdrawn at the 6th day after operation, good liverallograft functional recovery was achieved, without such complications as pancreatitis, thrombosis, and localized infections.Conclusion End-stage liver disease with concomitant insulin-dependent diabetes is the indication for combined liver-pancreastransplantations, for which simultaneous orthotopic liver and heterotopic pancreas-duodenum transplantations may constitutethe optimal surgical approaches as the primary choice.