改良式胰肾联合移植1例并文献复习

目的探讨改良式胰肾联合移植治疗2型糖尿病合并终末期肾病的移植效果。方法为1例2型糖尿病合并终末期肾病患者行改良式胰肾联合移植,其中移植胰腺的外分泌采用胰液空肠内引流术式,将供胰十二指肠节段与受体上段空肠直接行侧侧吻合。结果术后围手术期移植肾稳定泌尿,3800～4500ml/24h,3d后血清肌酐降至正常水平。术后胰腺功能恢复顺利,血、尿淀粉酶逐渐下降并稳定在正常范围,空腹血糖也于术后10d恢复至正常值范围以内。切口一期愈合,于术后两周出院。随访27个月移植肾功能正常,胰腺功能正常,未发生血栓、胰瘘、胰腺炎、排斥反应等并发症。结论改良式胰肾联合移植技术简单、安全,胰液经空肠引流更接近消化生理,是治疗糖尿病合并终末期肾病的有效手术方式。

Modified simultaneous pancreatic-kidney transplantation with enteric drainage of exocrine pancreatic secretions:one case report and literature review

Objectives To explore the effect of the modified simultaneous pancreatic-kidney transplantation（SPK）as the preferred treatment for patients with type 2 diabetic mellitus（T2DM）associated with uremia.Methods Modified SPK with the enteric drainage（ED）of exocrine pancreatic secretions was performed on one patient suffering from T2DM and uremia.And the allograft exocrine secretions was drained into the proximal jejunum via a side-to-side duodenojejunostomy（no Roux-en-Y）.Results Successful recovery of the kidney and pancreas grafts were observed.The laboratory examination showed continuous decreased serum creatinine（Scr）and the level of Scr was almost back to normal on day 3 post-transplantation.The serum and urinary amylase of this patient were returned to normal.And the fasting blood glucose levels were also returned to normal in 10 days after transplantation.The patient was discharged from hospital 14 days after transplantation and had been followed up for 27 months.The kidney graft and pancreatic allograft of function of the patient were all normal during follow-up.The patient had no complication such as graft thrombosis,pancreatic fistula,pancreatitis and rejection.The function of pancreas and kidney grafts remained normal up till now.Conclusion The modified ED-SPK without Roux-en-Y is a simple,safe and effective treatment for T2DM with uremia.