胰肾联合移植临床研究
摘要
目的:探讨胰肾联合移植治疗胰岛素依赖型糖尿病合并尿毒症的手术方式及移植疗效。方法:对2例胰岛素依赖型糖尿病合并尿毒症患者施行膀胱引流式全胰、十二指肠及肾一期移植,术后采用抗淋巴细胞球蛋白诱导,普乐可复、骁悉及强的松四联治疗的免疫抑制方案。结果:术后二天移植肾和胰腺功能恢复正常,并停用胰岛素,其中1例已随访6年,一般状况良好,胰、肾功能正常,完全停用胰岛素及降糖药物,无泌尿系统并发症及代谢性酸中毒表现。结论:胰腺联合移植是目前治疗糖尿病合并尿毒症最有效的手段。
ObjectiveTo evaluate the efficacy and safety of simultaneous pancreas-kidney transplantation(SPKT) for treatment of insulin-dependent diabetes mellitus (IDDM) with uremia. Method: SPKT was performed on 2 uremic patients with diabetes mellitus. Bladder drainage was used for management of pancreas exocrine secretions. The patients were treated with ATG+FK506+MMF+Pred as immnosuppressive treatment. Results: The renal and pancreatic graft regained normal function. The serum creatinine, C-peptide and blood glucose decreased to normal levels 2 days after operation and supplementation insulin was completely stopped. One case had survived with normal grafts function for six yeays. No complications such as urinary infection and metabolic acidosis occurred. Conclusion: SPKT is an effective method for the treatment of IDDM with uremia.
ObjectiveTo evaluate the efficacy and safety of simultaneous pancreas-kidney transplantation(SPKT) for treatment of insulin-dependent diabetes mellitus (IDDM) with uremia. Method: SPKT was performed on 2 uremic patients with diabetes mellitus. Bladder drainage was used for management of pancreas exocrine secretions. The patients were treated with ATG+FK506+MMF+Pred as immnosuppressive treatment. Results: The renal and pancreatic graft regained normal function. The serum creatinine, C-peptide and blood glucose decreased to normal levels 2 days after operation and supplementation insulin was completely stopped. One case had survived with normal grafts function for six yeays. No complications such as urinary infection and metabolic acidosis occurred. Conclusion: SPKT is an effective method for the treatment of IDDM with uremia.
引文
1,夏穗生主编,临床移植医学。浙江:浙江科学技术出版社,1999。
2,吴德全,陈昭彦,张新宇等 胰肾联合移植术的供体切取与修剪 肝胆胰外科杂志 2002,14(2):68
3,Wright FH, Wright C, Ames SA, et al. Pancreatic allograft thrombosis: donor and recieval factors and early post-perfusion graft function. Transplantation Pro 1990,22:439
4,Kuroda Y, Fujino Y, Morita A, et al. Correlation between high adenosine triphosphate tissue concentration and good posttransplant outcome for the canine pancreas graft after preservation by the two-layer cold storage method. Transplantation, 1991,52:989
5,Morita A, Kuroda Y, Fujino Y, et al. Assessment of pancreas graft viability preserved by a two-layer(Unversity of Wisconsin solution/perflurochemical) method after significant warm ischemia. Transplantation Pro, 1990,22:439
6,Dicarlo V, CasboldiR, Cristallo M, et al. Techniques of pancreas Transplantation through the world: An IPITA center survey. Transplant Pro, 1998,30:231
7,Sollinger HW, Vernon WB, D Alessandro AM, et al. combined liver and pancreas procurement with Belzer UW solution. Surgery, 1989,106:685
8,Dunn DL, Morel P, Schlumpp R, et al. Eridence that combined procurement of pancreas and liver grafts does not affect transplant outcome. Transplantation,1991,51:150
[1] Sutherland DE.Pancreatic transplantation state of the art.Transplant Proc,1992;24(3):762-766.
[2] Kirvela M,Scheinin M,Lindgren L.Haemodynamic and catecholamine responses to induction of anaesthesia and tracheal intubation in diabetic and non-diabetic uraemic patients.Br-J-Anaesth,1995.74:60.65.
[3] Hakim NS,Danovitch GM.Transplantation surgery .Great Britain: Springer Verlag London Ltd,2001:211-234,355-372.
[4]喻红辉,罗爱林,田玉科.胰肾联合移植术的麻醉管理.中华麻醉学杂志,2001,8:502-503.
[5] Kobza I,Zhuk R,Yeliseev G,et a1.Renal transplantation—choice of anesthesia.Wiad-Lek,1997,50 Suppl 1:447—448.
[6] Stanley GD,Pierce ET,Moore Wj,et a1.Spinal anesthesia reduces oxygen consumption in diabetic patients prior to peripheral vascular surgery.Ret—Anesth,1997,22:53—58
[7] Canovas L,Lopez R,Dominguez M,et al.Cardiorespiratory failure and diabetic autonomic neuropathy: A case report .Rev Esp Anesthesiol Reanim,1998;45(9):397-400.
[8] Lluch FM,Vallejo UA,Vallejo CF,et al.Anesthesia and intraoperative treatment in 2 cases of simultaneous liver,pancreas,and kidney transplantation .Rev Esp Anestesiol Reanim,1999;46(5):215-218.
[9]Ikeda K,Maoka H,Yoshimatsu N,et a1.Hemedynamic changes secondary to overload infusion during cadavefic renal transplantation. comparison between nitrous oxide-isoflurane anesthesia and continuous epidural anesthesia.Masui,1993,42:835.839.
1. 王亚伟,石炳毅,何长民 糖尿病肾病替代治疗 何长民主编,肾脏替代治疗学。上海:上海科学技术出版社
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3. 明长生,沙波,曾凡军,等. 改良胰液空肠引流式胰肾一期联合移植二例报告. 中华器官移植杂志, 2001,22:218~220
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16.Douzdjian V, Abecassis MM, cooper JL, et al. Incidence, management and significance of surgical complications after pancreatic transplantation. Surg GO, 1993,177:451
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6. Sollinger HW. Current status of simultaneous pancreas-kidney transplantation. Transp Proc,1994,26:375
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8.Gruesser AG, Sutherland DER, Gruessner RWG. Report of the international pancreas transplant registry. Transplant Proc, 1998;30:242
1, Gruessner RWG, Sutherland DER, Troppmann C, et al. The surgical risk of pancreas transplantation in the cyclosprine era: an overview. J Am Coll Surg,1997,185:128-144.
2, Gruesser AG, Sutherland DER, Gruessner RWG. Report of the international pancreas transplant registry. Transplant Proc, 1998;30:242
3, 郑树森,朱琮,陈江华,等. 胰十二指肠及肾一期联合移植三例体会. 中华器官移植杂志,1998,19:94-96.
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10, Sollinger HW. Pancreatic transplantation and vascular graft thrombosis. J Am Coll Surg,1996,182:362-363.
11, Sollinger HW. Current status of simultaneous pancreas-kidney transplantation. Transp Proc,1994,26:375
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13, 梁廷波 膀胱引流式胰、肾联合移植长期存活患者代谢性酸中毒的转归 中华器官移植杂志,2003,24(1):39-40 施乾锋
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2,吴德全,陈昭彦,张新宇等 胰肾联合移植术的供体切取与修剪 肝胆胰外科杂志 2002,14(2):68
3,Wright FH, Wright C, Ames SA, et al. Pancreatic allograft thrombosis: donor and recieval factors and early post-perfusion graft function. Transplantation Pro 1990,22:439
4,Kuroda Y, Fujino Y, Morita A, et al. Correlation between high adenosine triphosphate tissue concentration and good posttransplant outcome for the canine pancreas graft after preservation by the two-layer cold storage method. Transplantation, 1991,52:989
5,Morita A, Kuroda Y, Fujino Y, et al. Assessment of pancreas graft viability preserved by a two-layer(Unversity of Wisconsin solution/perflurochemical) method after significant warm ischemia. Transplantation Pro, 1990,22:439
6,Dicarlo V, CasboldiR, Cristallo M, et al. Techniques of pancreas Transplantation through the world: An IPITA center survey. Transplant Pro, 1998,30:231
7,Sollinger HW, Vernon WB, D Alessandro AM, et al. combined liver and pancreas procurement with Belzer UW solution. Surgery, 1989,106:685
8,Dunn DL, Morel P, Schlumpp R, et al. Eridence that combined procurement of pancreas and liver grafts does not affect transplant outcome. Transplantation,1991,51:150
[1] Sutherland DE.Pancreatic transplantation state of the art.Transplant Proc,1992;24(3):762-766.
[2] Kirvela M,Scheinin M,Lindgren L.Haemodynamic and catecholamine responses to induction of anaesthesia and tracheal intubation in diabetic and non-diabetic uraemic patients.Br-J-Anaesth,1995.74:60.65.
[3] Hakim NS,Danovitch GM.Transplantation surgery .Great Britain: Springer Verlag London Ltd,2001:211-234,355-372.
[4]喻红辉,罗爱林,田玉科.胰肾联合移植术的麻醉管理.中华麻醉学杂志,2001,8:502-503.
[5] Kobza I,Zhuk R,Yeliseev G,et a1.Renal transplantation—choice of anesthesia.Wiad-Lek,1997,50 Suppl 1:447—448.
[6] Stanley GD,Pierce ET,Moore Wj,et a1.Spinal anesthesia reduces oxygen consumption in diabetic patients prior to peripheral vascular surgery.Ret—Anesth,1997,22:53—58
[7] Canovas L,Lopez R,Dominguez M,et al.Cardiorespiratory failure and diabetic autonomic neuropathy: A case report .Rev Esp Anesthesiol Reanim,1998;45(9):397-400.
[8] Lluch FM,Vallejo UA,Vallejo CF,et al.Anesthesia and intraoperative treatment in 2 cases of simultaneous liver,pancreas,and kidney transplantation .Rev Esp Anestesiol Reanim,1999;46(5):215-218.
[9]Ikeda K,Maoka H,Yoshimatsu N,et a1.Hemedynamic changes secondary to overload infusion during cadavefic renal transplantation. comparison between nitrous oxide-isoflurane anesthesia and continuous epidural anesthesia.Masui,1993,42:835.839.
1. 王亚伟,石炳毅,何长民 糖尿病肾病替代治疗 何长民主编,肾脏替代治疗学。上海:上海科学技术出版社
2. 陈实,夏穗生, 何刚,等. 胰十二指肠及肾一期联合移植(附一例报告). 中华器官移植杂志1990, 11:63-65.
3. 明长生,沙波,曾凡军,等. 改良胰液空肠引流式胰肾一期联合移植二例报告. 中华器官移植杂志, 2001,22:218~220
4.郑树森, 梁廷波, 陈江华, 等. 胰、十二指肠及肾一期联合移植并发症的处理. 中华器官移植杂志, 2000, 21:177~179.
5 . Sollinger HW, Cook K, Kamps D, et al. Clinical and experimental experience with pancreaticocystostomy for exocrine pancreatic drainage in pancreatic transplantation. Transplant Proc, 1984,16:749~531
6.Gruessner A, Sutherland DER. Pancreas transplantation in the united states (US) and non-US as reported to the United Network for Organ Sharing (UNOS) and the International Pancreas Transplant Registry (IPTR). In: Cecka JM, Terasaki PI, eds. Clinical Transplants 2000. Los Angeles: UCLA Tissue TypingLaboratory, 2001. 45~72
7.Büsing M, Martin D, Schultz T, et al. Pancreas-kidney transplantation with urinary bladder and enteric exocrine diversion: seventy cases without anastomotic complications. Transplant Proc, 1998, 30:434~437.
8.Stephen T, Barlett MD. Techiniques of pancreatic duct implantation. Cur Opin in Organ Transplant, 1998, 3:248~252
9.Sutherland DER, State of the art in pancreas transplantation. Transplant Pro,1994,26:316
10.Cantarovichd, Paineau, J, Karam G, et al. Five-year experence with segmental duct-occluded pancreatic grafts. Transplant Pro, 1994,26:416
11.Earnhardt RC, Kindler DD, Weaver AM, et al. Hyperinsulinemia after pancreatic ransplantation. Ann Surg, 1993,218:428
12.Lowell JA, Bynon JS, StattaRT, et al. Superior mesenteric arteriovenous fistula in vascularized whole organ pancreatic allografts. Syrg GO. 1993,177:254
13.Gaber AO, Shokouh AH, Hathaway DK, et al. Pancreas transplantation with portal venous and enteric crrainage eliminate hyperinsulinemia and reduces postoperative conplications. Transplantation Pro,1993,25:1176
14.Gaber AO, Shokouh AH, Grewal HP, et al. Technique for portal pancreatic transplantation with enteric drainage. Surg GO, 1993,177:417
15.Vay Liang W. Thepancreas: Boolgy, Pathobiology, and Disease. 2nd edition. New York. 1993,815～834
16.Douzdjian V, Abecassis MM, cooper JL, et al. Incidence, management and significance of surgical complications after pancreatic transplantation. Surg GO, 1993,177:451
1. Sutherland DE,Cecka M,Gruessner AC et al. Reportfromthe International Pancreas Transplant Registry-1988. Transplant Pro,1999,31:597
2.Tyden G, Bolinder J, Solders G, et al. A 10 year prospective study of IDDM patients subjected to combined pancreas and kidney transplantation or kidney transplantation alone. Transplant Proc, 1998;30:332
3. Sutherland DE,Pancreas and pancreas-kidney transplantation. Curr Opin Nephrol Hypertens,1998,7(3):317
4. Sugitani A, Gritsch HA, Shapiro R, et al. Surgical complications in 123 consecoutive pancreas transplantation recipients: comparison of bladder and enteric drainage. Transplant Proc, 1998;30:293
5. Busing M, Martin D, Schulz T, et al. Pancreas-kidney transplantation with urinary bladder and enteric exocrine diversion: seventy cases without anastomotic complications. Transplant Proc, 1998;30:434
6. Sollinger HW. Current status of simultaneous pancreas-kidney transplantation. Transp Proc,1994,26:375
7. Kaufman DB,Kaplan B,Kanwar YS et al. The successful use of FK506 in a pancreas-kidney transplant recipient with recurrent cyslosporine-associated hemolytic ureic syndrome. Transplantation,1995,59:1737
8.Gruesser AG, Sutherland DER, Gruessner RWG. Report of the international pancreas transplant registry. Transplant Proc, 1998;30:242
1, Gruessner RWG, Sutherland DER, Troppmann C, et al. The surgical risk of pancreas transplantation in the cyclosprine era: an overview. J Am Coll Surg,1997,185:128-144.
2, Gruesser AG, Sutherland DER, Gruessner RWG. Report of the international pancreas transplant registry. Transplant Proc, 1998;30:242
3, 郑树森,朱琮,陈江华,等. 胰十二指肠及肾一期联合移植三例体会. 中华器官移植杂志,1998,19:94-96.
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