胰肾联合移植的实验研究和临床应用

目的　建立胰肾联合移植(SPKT)大动物模型,进而应用于临床Ⅰ型糖尿病肾衰的病人。方法　选用杂种猪作SPKT的供受体,供体门静脉远端与左肾静脉吻合,近端及带腹腔、肠系膜上和左肾动脉的腹主动脉段分别与受体下腔静脉及肾以下腹主动脉端侧吻合,十二指肠吻合于膀胱,输尿管置管外引流,未作预防及抗排斥处理。此后取无心跳供体胰肾分别移植于Ⅰ型糖尿病肾衰患者的两侧髂窝,血管均分别吻合于两侧髂外动、静脉,输尿管及十二指肠吻合于膀胱左右侧。结果　13头移植猪中2头死于内环境紊乱及吻合口出血,其余11头平均存活(9.1±2.4)d。接受移植的病人胰肾功能恢复良好,已存活7个多月。结论　建立猪SPK模型是可行的,SPK对Ⅰ型糖尿病肾衰患者有确切疗效。

Experimental research and clinical application of simultaneous pancreas-kidney transplantation

Objective　To establish the model of simultaneous pancreas-kidney transplantation (SPKT) in pigs and further use it in treatment of renal failure in patients with late-stage type Ⅰ diabetes mellitus. Methods　Hybrid pigs were used as donors and recipients. A renoportal end-to-end anastomosis between the left renal vein and the distal end of portal vein was performed firstly, then the proximal end of portal vein was anastomosed with recipient inferior vena cava in the end-to-side form. The arterial blood supply was constructed with end-to-side anastomosis between the donor's aortic segments including the celiac, superior mesenteric and left renal arteries and recipient's abdominal aorta at the level inferior to renal arteries. Pancreatic exocrine secretion drainage was established with duodenocystostomy. The ureterostomosis of the graft was performed. No immunosuppressive agent was administered to the pigs. One patient with late-stage type Ⅰ diabetes mellitus received the SPKT. Results　Of the 13 pigs, 2 died of disturbance of internal environment and anastomosis bleeding respectively and the others survived for a mean of 9.1±2.4 days. The patient has survived for over 7 months with normal levels of blood glucose, serum creatinine and BUN. Conclusions　Establishment of the model of SPKT in pigs is feasible, SPKT is effective in treating renal failure in patients with late-stage type I diabetes mellitus.