临床胰肾联合移植进展

胰肾联合移植（SPK）是治疗胰岛素依赖型糖尿病并发尿毒症及尿毒症合并有糖尿病的有效方法，胰腺移植之后可获得正常的糖代谢，不需要外源性胰岛素并可逆转糖尿病的并发症和提高生活质量，采用外源性胰岛素的替代疗法并不能防止糖尿病并发症的发生，肾脏移植之后使尿毒症得到纠正，自1966年首例临床胰腺十二指肠移植成功以来，到1994年底，全球单一胰腺移植1600例。有131个移植中心施行胰肾联合移植5628例，移植患者1年与5年存活率分别为91％和78％目前，胰肾联合移植仅次于肾，肝、心移植，居第4位，现将胰肾联合移植进展分述如下：一、…     

临床胰腺与胰肾联合移植研究进展

胰肾联合移植已成为治疗Ⅰ型糖尿病、部分Ⅱ型糖尿病合并尿毒症有效的常规方法.有关移植胰外分泌引流方式的选择.移植胰静脉回流途径以及免疫抑制剂的应用等方面,近年都取得一些进展.     

临床胰腺与胰肾联合移植研究进展

胰肾联合移植已成为治疗Ⅰ型糖尿病、部分Ⅱ型糖尿病合并尿毒症有效的常规方法。有关移植胰外分泌引流方式的选择。移植胰静脉回流途径以及免疫抑制剂的应用等方面,近年都取得一些进展。     

胰肾联合移植研究进展

自1966年首例胰肾联合移植（pancreas-kidney transplants．PKT）在美国Minnesota大学成功实施以来[11．随着新型免疫抑制剂的临床应用、器官保存技术和手术方式的改进．胰肾联合移植成功率显著提高。据国际胰腺移植登记机构（International Pancreas Transplant Registry，IPTR）记录，至2003年全球已实施21208例胰腺移植，其中多数是胰肾联合移植。胰肾联合移植已成为治疗Ⅰ型糖尿病和部分Ⅱ型糖尿病合并尿毒症的有效常规方法。     

胰肾联合移植

胰肾联合移植(SPK)对于胰岛素依赖型糖尿病并发尿毒症及尿毒症合并有糖尿病的治疗具有重要的临床意义,本文就病人的选择、器官的切取和保存、SPK的外科技术、排斥反应、免疫治疗、SPK的发展趋势6个方面进行了综述。     

胰腺与胰肾联合移植免疫抑制剂的应用

目前已公认胰腺与胰肾联合移植是治疗Ⅰ型糖尿病(IDDM)及其并发症的安全、有效方法。移植的最终目的是彻底根治IDDM，完全停用外源性胰岛素，消除或改善糖尿病并发症，提高生活质量。由于糖尿病病变的特殊性、移植胰排斥反应发生率和移植物丢失率高以及术后免疫抑制剂引起的副作用，如：高血压、高脂血症和移植后糖尿病(PTDM)等因素，胰腺与胰肾联合移植术后免疫抑制剂的选择与应用比单纯肾移植更复杂，涉及问题更多。本文就胰腺及胰肾联合移植术后免疫抑制的临床应用及进展作一概述。     

全胰、肾一期联合移植一例

目的 总结临床胰、肾联合移植的经验与教训。方法 对１例胰岛素依赖型糖尿病合并尿毒症患者施行膀胱引流式尸体全胰、十二指肠及肾一期联合移植。术后采用包括抗淋巴细胞诱导的四联序贯免疫抑制方案,维持免疫抑制彩环孢素Ａ、泼尼松和霉酚酸酯组成的三联方案。结果 术后第４ｄ,移植肾和胰腺功能恢复良好,血肌酐、尿素氮及空腹血糖降至正常,术后２０ｄ,完全停用胰岛素,患者现已存活９个月,情况良好。结论 胰、肾联合移植应     

胰、肾联合移植六例报告

目的 探讨胰、肾联合移植治疗糖病合并糖尿病肾病的疗效。方法 回顾分析近期施行的6例胰、肾联合移植手术的方法、疗效及并发症的防治。结果 6例患者分别于移植胰腺恢复血液循环后23h、第9d、17h、19h、第5d及1．5h停用外源性胰岛素,移植肾功能于术后第2－4d恢复正常;术后并发症有排斥反应和血尿,其中1例术后5d发生加速性排斥反应,抗排斥治疗无效,于术后11d切除移植胰、肾,其余5例均痊愈出院。结论 胰、肾联合移植是治疗胰岛素依赖型糖尿病及达到胰岛素依赖期的非胰岛素依赖型糖尿病合并糖尿病合并糖尿病肾病的有效方法;加强围手术期管理术后减少各种并发症、取得良好疗效的有效措施。     

胰肾联合移植进展

胰腺移植发展较为曲折。早在19世纪末，人们就开始探讨胰腺移植治疗糖尿病的可能性，直到1966年明尼苏达大学的Kelly教授才首次施行了节段胰腺移植，步入临床应用阶段。据国际胰腺移植登记中心（IPTR）及全美器官分配网络（UNOS）统计，目前全球已经实施了近20000例胰腺移植手术，其中83％为胰肾联合移植，人及移植物生存率由最初的70％／50％上升到95％／84％，成为治疗糖尿病的最佳手段。[第一段]     

胰、十二指肠及肾一期联合移植并发症的处理

目的 探讨胰肾一期联合移植术后并发症的处理经验。方法 回顾性分析５例胰、十二指肠及肾一期联合移植术后发生并发症的原因及治疗。结果 ５例术后分别存活５年１个月、４年、２２ｄ、７０ｄ和５个月,前２例目前仍健在,生活质量佳。５例均发生了近期或远期的非技术性并发症,其中包括胰瘘、胰周感染及脓肿、十二指肠残端瘘、膀胱炎、血尿、排斥反应、巨细胞病毒感染、代谢性酸中毒、尿潴留与尿道狭窄等。结论 胰、肾一期联合移     

Anesthetic management of combined kidney and pancreas transplantation

Combined kidney and pancreas transplantation was performed for the first time in Japan in a 29-year-old diabetic male with end stage renal nephropathy. He previously required injections of 44 IU insulin daily, and the fasting plasma glucose concentration before the transplant was 722 mg/dl. Anesthesia was maintained with fentanyl, nitrous oxide (70%) and halothane (0 approximately 1.0%). A continuous infusion of intravenous regular insulin (2 approximately 8 IU/hr) was started after induction of anesthesia. After revascularization of the pancreatic graft, his plasma glucose concentration fell from 350 mg/dl to 130 mg/dl in one hour and a half. Blood glucose level was maintained between 200 to 300 mg/dl without insulin during anesthesia and thereafter. The grafted kidney and pancreas showed good function during this period. In this report, anesthetic problems in combined kidney and pancreas transplantation were discussed.     

Combined pancreas kidney transplantation after isolated kidney transplantation

Simultaneous pancreas kidney transplantation (SPK) is an established therapy for type 1 diabetics with end stage or preterminal renal disease. SPK is superior to isolated kidney transplantation (KTX) in diabetic patients. Even pancreas-re-transplantations are more common in these patients now, mostly after SPK. But Experience with SPK after KTX is rare. Between 1994 and 2003 six Re-SPK 4.5 to 8.5 years after KTX were performed in our department. Average age of the recipients was 40.5 years. They had been suffering from diabetes for an average of 29.3 years. Four recipients were on dialysis again, whereas two had preterminal renal insufficiency. Pancreas transplants were drained through the bladder (n = 1) or into the small intestine (n = 5) with systemic venous anastomosis. After a median observation period of 28 months (8 to 99 months) all six recipients are insulin free. One patient lost his kidney graft due to severe acute rejection. Therefore kidney graft survival is 83 %. Four acute rejections (66 %) were observed in 4 patients. Only one rejection was treated successfully by steroids. Two rejections could be stopped with antibodies. 3 patients had infections in the early postoperative period (sinusitis, urinary tract infection, wound infection). Even after KTX with graft failure, diabetic patients suffering from renal disease can be re-transplanted successfully with SPK.     

Does combined kidney and pancreas transplantation reverse functional diabetic microangiopathy?

Abstract. Using videophotometric capillaroscopy and laser Doppler fluxmetry, we have investigated skin microvascular reactivity in the fingers of 14 diabetic patients with severe, late complications 20 months after combined kidney and pancreas transplantation. The results were compared with those obtained in 20 diabetic patients awaiting pancreas transplantation and in 19 healthy subjects. The capillary blood cell velocity at rest ( P < 0. 01) and during postocclusive reactive hyperemia ( P < 0. 05) was significantly lower in both patient groups than in the healthy controls. However, the time to peak capillary blood cell velocity during hyperemia was normal in the post-transplantation group (NS) but significantly prolonged in the pretransplantation group ( P < 0. 01). The ability to decrease flow during venous stasis-the so called venoarte-riolar reflex-was strongly impaired in the pretransplantation group ( P < 0. 001) but less so in the post-transplantation group ( P < 0. 05) as compared to healthy controls. It may be concluded that diabetic patients. after combined kidney and pancreas transplantation, show a tendency towards better microvascular reactivity than those awaiting transplantation.     

Does combined kidney and pancreas transplantation reverse functional diabetic microangiopathy?

Using videophotometric capillaroscopy and laser Doppler fluxmetry, we have investigated skin microvascular reactivity in the fingers of 14 diabetic patients with severe, late complications 20 months after combined kidney and pancreas transplantation. The results were compared with those obtained in 20 diabetic patients awaiting pancreas transplantation and in 19 healthy subjects. The capillary blood cell velocity at rest (P<0.01) and during postocclusive reactive hyperemia (P<0.05) was significantly lower in both patient groups than in the healthy controls. However, the time to peak capillary blood cell velocity during hyperemia was normal in the post-transplantation group (NS) but significantly prolonged in the pretransplantation group (P<0.01). The ability to decrease flow during venous stasis—the so called venoarte-riolar reflex—was strongly impaired in the pretransplantation group (P<0.001) but less so in the post-transplantation group (P<0.05) as compared to healthy controls. It may be concluded that diabetic patients, after combined kidney and pancreas transplantation, show a tendency towards better microvascular reactivity than those awaiting transplantation.     

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据国际胰腺移植登记中心 (ＩＰＴＲ)及全美器官分配网络 (ＵＮＯＳ)统计 ,至 2 0 0 0年 10月 ,已经接受胰腺移植超过15 0 0 0例 ,其中 87%为胰肾联合移植。人 /移植胰腺 /肾 1年生存率达 95 % /90 % /84% ,5年生存率达 82 % /70 % /6 6 %。目前胰肾联合移植已成功进入临床应用阶段 ,成为治疗糖尿病合并糖尿病肾病的最佳手段。1　历史回顾早在 1889年Ｍｅｒｉｎｇ和Ｍｉｎｋｏｗｓｋｉ就提出胰腺移植治疗糖尿病的设想 ,1892年开始正式实验研究。 2 0世纪 6 0年代实验基本成熟 ,开始将该技术应用于临床。 196 6年明尼苏达大学的Ｋｅｌｌｙ教授…