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目的总结胰肾联合移植患者长期存活的临床经验。方法2001年10月至2004年7月行胰肾联合移植术6例,均采用供者十二指肠与受者空肠侧侧吻合的改良式胰液肠腔引流术式,术前口服吗替麦考酚酯500mg,他克莫司2mg,术中用甲泼尼龙(MP)1.0g。术后2例用2剂抗白细胞介素2受体单克隆抗体,4例用抗胸腺细胞球蛋白诱导治疗,术后1～3d分别用MP冲击治疗,术后第2天开始应用他克莫司、吗替麦考酚酯、泼尼松三联免疫抑制治疗方案维持治疗。每日用那屈肝素钙(速避凝)或前列地尔等抗凝药物防止移植胰腺血栓形成。应用生长抑素预防移植胰胰腺炎。术后3～5d肾功能恢复顺利时加用更昔洛韦预防巨细胞病毒感染。术后随访15～49个月。结果6例手术均获成功。术后血糖6～16mmol/L,应用小剂量胰岛素5～10d后停用,6例患者血糖均维持在正常范围。1例术后第7天出现他克莫司浓度过高所致肾中毒,经血液透析治疗3次,他克莫司减量后,肾功能恢复正常。3例患者分别于术后第14、20、22天并发消化道出血,经对症治疗后出血停止。术后早期未发生胰瘘、肠瘘和血栓形成等并发症。6例均存活,存活4年以上者1例,3年以上者3例,2年和1年以上者各1例。胰腺功能良好,血糖正常。5例血肌酐(Scr)正常；1例Scr＞400μmol/L。结论胰肾联合移植是治疗I型糖尿病合并终末期肾病的有效方法,改良式胰-十二指肠及肾一期联合移植术手术操作相对简单,更符合生理,术后并发症少。供器官质量、组织配型、胰液引流方式、围手术期合理用药和术后远期感染是影响患者术后长期存活的重要因素。
Objective To summarize the clinical experience of long-term survival in pancreas-kidney transplantation. Methods From October 2001 to July 2004, 6 cases of pancreas-kidney combined transplantation were treated by modified intestine drainage of the intestine of the donor duodenum and jejunum, Phenol 500mg, 2mg tacrolimus, intraoperative use of methylprednisolone (MP) 1.0g. Two patients were treated with 2 doses of anti-IL-2 monoclonal antibody, 4 patients were treated with anti-thymocyte globulin, and 1 ~ 3 days after operation were treated with MP shock respectively. On the second day after operation, tacrolimus Division, mycophenolate mofetil, prednisone triple immunosuppressive regimens for maintenance treatment. Pancreas thrombosis was prevented daily with naltrexone calcium (contraceptive) or alprostadil. Use of somatostatin in the prevention of pancreatic pancreatitis. 3 ~ 5d postoperative recovery of renal function with ganciclovir plus cytomegalovirus infection prevention. Follow-up 15 to 49 months after surgery. Results 6 cases of surgery were successful. Postoperative blood glucose 6 ~ 16mmol / L, the application of small doses of insulin 5 ~ 10d disabled, 6 patients with blood glucose remained within the normal range. One case had renal toxicity caused by too high concentration of tacrolimus on the 7th day after operation. After hemodialysis treatment for 3 times, the renal function returned to normal after the reduction of tacrolimus. Three patients were bleeding on the 14th, 20th and 22nd day after operation, respectively. Bleeding was stopped after symptomatic treatment. No postoperative pancreatic fistula, intestinal fistula and thrombosis and other complications. 6 patients survived more than 4 years in 1 case, 3 years more than 3 cases, 2 years and 1 year in 1 case. Pancreatic function, normal blood sugar. 5 cases of normal serum creatinine (Scr); 1 case of Scr> 400μmol / L. Conclusions Combined pancreas and kidney transplantation is an effective method for the treatment of type 1 diabetes mellitus combined with end-stage renal disease. The modified pancreaticoduodenal and renal combined transplantation is relatively simple and more physiologically compatible with less postoperative complications. Organ quality, tissue matching, drainage of pancreatic juice, perioperative rational use of drugs and long-term postoperative infection are important factors that affect long-term survival of patients.