胰液空肠引流术式胰肾联合移植(附10例报告)

总结10例胰液空肠引流(ED)术式胰肾一期联合移植(SPK)的外科技术和治疗胰岛素依赖型糖尿病(IDDM)合并尿毒症的效果。方法2000年6月至2003年7月间完成改进的ED术式SPK10例，不做Roux-en-Y吻合。免疫抑制治疗术后早期采用四联诱导治疗(FK506／CsA MMF 皮质激素 ALG或抗CD25单抗)，以后改为三联维持。结果10例手术均获得成功，移植肾功能即刻恢复，除1例移植胰功能延迟恢复外．余9例术后1周内血糖降至正常水平，完全停用外源性胰岛素。1例术后6月带正常移植物功能死于心肌梗塞，4例存活已超过1年；发生急性排斥反应4例次。除1例难治性排斥未能逆转行再次肾移植外．余3例经激素冲击或()KT3治疗均获好转。并发症情况：出现腹腔感染与切口感染各2例，肾周血肿1例，分别经手术探查或引流换药治疗后愈合。结论改进的ED术式胰肾联合移植安全、简单，无严重外科并发症，是值得推广的治疗IDDM合并尿毒症的理想方法。

SIMULTANEOUS PANCREATIC KIDNEY TRANSPLANTATION WITH ENTERIC DRAINAGE OF EXOCRINE PANCREATIC SECREATIONS-10 CASES REPORTS

Objective To summarize the results of simultaneous pancreatic kidney transplantation (SPK) with enteric drainage (ED) in the treatment of insulin dependent diabetes mellitus (IDDM) with uremia.Methods From June 2000 to July 2003, 10 cases of IDDM with uremia received SPK. The pancreatic allograft exocrine secretion was drained into the proximal jejunum via a side to side duodenojujunostomy (no Roux en Y). Quadruple immunosuppressive regimes included tacrolimus/cyclosporine, mycophenolate mofetil (MMF), steroid and antibodies induction which included antilymphocyte globulin (ALG) or anti CD25 monoclonal antibody.Result ED SPK without Roux en Y was successfully applied to all patients without serious complications such as pancreatitis, graft thrombosis and pancreatic fistula. The patients haveachieved immediate kidney allograft function and euglycemia with insulin independent. Episodes of acute rejection were observed in 4 cases, and 3 of them were reversed effectively. Early postoperative complications involved peritoneal infection (2/10), wound infection (2/10) and bleeding (1/10). Conclusion ED SPK without Roux en Y is preferable to the patients of IDDM with uremia.