胰肾联合移植治疗1型糖尿病合并终末期肾病1例报告并文献复习

目的探讨胰肾联合移植治疗糖尿病合并终末期肾病的手术方式及移植效果。方法对1例1型糖尿病合并糖尿病肾病、尿毒症患者施行胰肾联合移植手术,将肾脏移植于左侧髂窝,胰腺移植于右侧髂窝,胰腺移植采用胰腺外分泌肠道引流、内分泌体循环系统回流的术式(肠道-体循环回流术式);术后常规给予免疫抑制、防治感染、支持等治疗。结果受者手术顺利。联合移植后胰、肾均发挥正常功能,血清肌酐逐渐恢复正常水平,血糖趋于稳定,第14日完全停用胰岛素及降糖药物。无严重手术并发症发生,受者健康存活,门诊随访移植胰腺、肾脏功能正常。结论胰肾联合移植是治疗1型糖尿病合并终末期肾病的理想方法 。

Pancreas-kidney transplantation for the treatment of type 1 diabetes with end-stage renal disease: a case report and literature review

Objective To study the prognosis and operation techniques of simultaneous pancreatickidney transplantation （SPK） for the treatment of diabetes with end-stage renal disease. Methods The simultaneous pancreas-kidney transplantation was performed in 1 case which was diagnosed as type 1 diabetes mellitus with renal failure. Renal allograft was placed in the left iliac fossa and pancreas allograft in the right iliac fossa. The external secretion of pancreatic with intestinal drainage and the endocrine of pancreatic with systemic circulation system refluxing was adopted. Immunosuppression treatment, prevention of infection and other relevant supports were given after operation. Results The operation was snccessfully performed and the function of pancreas and kidney grafts recovered to normal after SPK. Serum creatinine recovered to normal level and blood glucose stayed steady with no insulin treatment within 14 days postoperatively. The recipient still survived after operation with no severe postoperative complications and the function of pancreas and kidney grafts retained normal during follow up. Conclusion SPK is considered as the treatment of choice in type 1 diabetes mellitus patients with renal failure.