肝肾胰联合移植的围手术期处理

目的总结肝胰肾联合移植围手术期处理的经验。方法报告肝、胰、肾一期联合移植治疗1例乙型肝炎后肝硬化、肝功能不全合并慢性肾功能不全伴慢性胰腺炎导致胰岛素依赖型糖尿病患者的临床特点及治疗体会。对患者围手术期处理及相关资料进行回顾性分析。结果采用胰液空肠内引流及原位背驮式同期尸体肝、胰、肾联合移植。手术顺利，移植肝脏及胰腺功能1周内逐渐恢复，肾功能延迟恢复。术后第16天因移植肾血流下降，切除移植肾脏，于原移植部位行第2次肾移植，肾功能逐渐恢复正常。至2005年11月随访10个月，患者未发生排斥反应及明显感染，移植肝、胰、肾功能均正常，一般情况良好。结论肝胰肾联合移植技术安全，术后因各脏器对功能恢复所需内环境各不相同，矛盾较多，围手术期处理对患者的长期存活至关重要。

Perioperative management of simultaneous liver, pancreas-duodenum and kidney transplantation

Objective To evaluate the perioperative management of triple organ(liver,kidney and pancreas) transplantation for patients with end-stage liver disease with renal failure and diabetes mellitus.Methods The clinical features and treatment of a 43-year-old male patient who underwent simultaneous liver,pancreas-duodenum and kidney transplantation(SLPKT) because of end-stage liver disease with renal failure and insulin-dependent diabetes mellitus were reported;and the relevant data of the perioperative management of this case was analyzed retrospectively.Results The triple solid organ transplantation was successful.Good liver and pancreas allograft functional recovery was achieved within 7 d after operation.However,the recovery of renal allograft function delayed.The renal allograft was removed on the 16th day after operation due to broken-down of renal blood flow;and a new renal transplantation was performed at the same position.The renal graft function recovered to normal 3 d later.Up to now,no acute rejection of the organs and no complications such as pancreatitis,thrombosis and localized infections occurred.The patient became insulin independent with normal function of the 3 graft organs.Follow-up of 10 months till now,the patient is alive with good general condition.Conclusions SLPKT offers an effective therapy for patients with end-stage liver disease with pancreatic and renal failure.The perioperative management of transplantation is essential to the recovery of the patient.