胰肾联合移植的围手术期处理体会

目的 总结肠腔引流式胰肾联合移植围手术期处理经验。方法 对2例糖尿病合并肾功能衰竭的患者行肠腔引流式胰肾联合移植术。术后采用他克莫司(FK506)、霉酚酸酯(MMF)及强的松龙(Pred)三联用药进行免疫抑制治疗；肝素和低分子右旋糖酐抗凝；阿昔洛韦、可耐抗病毒。结果 移植后，2例患者均立即停用胰岛素，血糖正常，肾功能正常。例1术后1周出现吻合口出血，术后2个月出现巨细胞病毒性肺炎并发ARDS；例2术后45d出现移植肾急性排斥反应。2例均治愈，目前已分别存活12个月、9个月，移植胰、肾功能正常，一般情况良好。结论 胰肾联合移植是治疗糖尿病合并肾功能衰竭的理想方法，围手术期处理是手术成功的重要环节。

Perioperative managements of simultaneous kidney-pancreas transplantation

Objective To sum up the experiences of simultaneous kidney-pancreas transplantation (SKPT) with enteric drainage of pancreatic secretion (ED).Methods SKPT with ED was performed on 2 cases of diabetes mellitus complicated with renal failure.FK506,MMF and Pred were applied for postoperative immunosupression,heparin and dextran-10 for anticoagulation,aciclovir and foscarnet for antivirus.Results Serum glucose and renal function of the two cases were normal without insulin post-SKPT.Anastomotic hemorrhage occurred in one case on 7 th day and cytomegaloviral pneumonia complicated with ARDS on 60 th day post-transplantation.Acute rejection of transplanted kidney occurred in another case on 45 th day post-operation.Two cases have survived for 12 and 9 months separately with the grafts and general conditions well.Conclusion SKPT with ED is an ideal way to treat diabetes mellitus complicated with renal failure.Correct preoperative managements are important for success of transplantation.