同种异体胰肾联合移植二例报告

目的：总结胰肾联合移植治疗糖尿病并发晚期肾功能不全病人的临床经验。方法：为2例糖尿病合并糖尿病肾病、肾功能衰竭患者施行胰、肾联合移植术，对手术技术、术后排斥反应的防治和其它非手术并发症的处理进行总结。结果：联合移植后2例胰肾均发挥正常功能，病人均立即停用胰岛素。例1术后发生移植肾急性排斥反应，合并间质性肺炎，移植胰腺胰瘘，胰周感染，死于多器官功能衰竭，例2术后2月时反复出现肉眼血尿、低热，经积极治疗症状消失，目前患者一般情况良好，正常饮食，可从事轻工作。结论：胰肾联合移植是治疗Ⅰ型糖尿病患者并发尿毒症的理想方法。术后并发症是移植失败的主要原因。胰外分泌的处理是胰移植的关键所在。胰液肠腔、膀胱引流式两种术式各有其优缺点，应根据患者的情况及各移植中心的条件选择。

Primary Pancreas-Kidney Transplantation :A Report of 2 Cases

Objective:To summary the experiences of primary pancreas-kidney transplantation.Methods: The combined pancreas-kidney transplantation was performed on 2 patients with diabetes mellitus associated with diabetic nephropathy or renal function failure from Sep.2003 to Jan.2004.The treating experiences of the operation skills,prevention of rejection and the management of non-technical complications were summarized.Results: Blood glucose of the two patients decreased to normal level without injection of insulin at 6 or 3 hours after operation.The serum creatinin and nitrogen were at normal level in 5 or 4 days postoperation.The first patients died from complications including pancreas leakage,peripancreatic infection and abscess,and rejection.The other patient have survived 14 months with a good life quality.Conclusion: Combined primary pancreas-kidney transplantation is an effective treatment for insulin-dependent diabetes mellitus patients associated with end-stage of renal failure or diabetic nephropathy.