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目的:探讨胰液膀胱引流式胰肾联合移植的远期效果及其影响因素。方法:2001年9月～2006年1月共为14例患者行同种异体胰、十二指肠及肾联合移植术。胰腺移植于右髂窝,门静脉与髂外静脉做端侧吻合,包括腹腔动脉干和肠系膜上动脉的腹主动脉片与髂外动脉做端侧吻合,肾脏同常规肾移植于左侧髂窝。十二指肠与膀胱侧侧吻合,胰液采用膀胱外引流。术后应用他克莫司加霉酚酸酯加泼尼松三联免疫抑制方案。结果:9例患者术后胰肾功能恢复良好,早期无排斥反应发生。随访18～70个月,平均34个月。存活5年以上者4例,4年以上者5例,3年以上者6例,1年以上者9例,胰肾功能良好,血糖正常,均未使用降糖药。1例因超急性排斥反应术后第2天切除移植胰腺,随访至今2年肾功能良好。4例死亡,其中3例死于心血管事件、多器官衰竭,1例因十二指肠瘘死亡。结论:仔细完善的围手术期管理、预防和及时处理并发症、合理应用免疫抑制剂是影响胰肾联合移植患者和移植物长期存活的重要因素。
Objective: To investigate the long-term effect and its influencing factors of pancreas-kidney drainage combined with pancreas drainage. Methods: From September 2001 to January 2006 a total of 14 patients underwent allogeneic pancreas, duodenum and kidney transplantation. Pancreatic transplantation in the right iliac fossa, portal vein and external iliac vein anastomosis, including the abdominal aortic artery and superior mesenteric artery of the abdominal aorta and external iliac artery end to end anastomosis, kidney with conventional renal transplantation in the left iliac fossa. Duodenal and lateral side of the anastomosis, pancreatic fluid drainage with the bladder. Postoperative application of tacrolimus plus mycophenolate mofetilin triple immunosuppressive regimen. Results: Nine patients had good recovery of pancreatic and renal function and no early rejection. Follow-up 18 to 70 months, an average of 34 months. 4 cases survived for more than 5 years, 5 cases more than 4 years, 6 cases more than 3 years, 9 cases more than 1 year, good pancreatic and renal function, normal blood glucose, did not use hypoglycemic agents. In 1 case, the pancreas was resected on the second postoperative day after hyperacute rejection, and the renal function was good for 2 years since follow-up. 4 died, 3 of them died of cardiovascular events, multiple organ failure, and 1 died of duodenal fistula. CONCLUSION: Careful perioperative management, prevention and prompt treatment of complications, and rational use of immunosuppressive agents are important factors affecting the long-term survival of pancreas and kidney transplantation patients and grafts.