De Pauw L, Ickx B, Fery F, Doutrelepont J M, Abramowicz D, Vereerstraeten P, Kinnaert P
H pital Erasme, Université Libre de Bruxelles, Belgium.
Transpl Int. 1994;7 Suppl 1:S420-2. doi: 10.1111/j.1432-2277.1994.tb01409.x.
We designed and performed on two patients a new surgical procedure of en bloc kidney and pancreatic transplantation. The liver, pancreas and kidneys were removed en bloc in the donor. On the bench, the liver and the left kidney were separated from the bloc, leaving the pancreas and the right kidney for combined kidney and pancreatic transplantation. The portal vein was divided near to the emergence of the splenic vein. The coeliac axis was taken with an aortic patch. The left renal vein was cut at its entrance to the inferior vena cava (IVC) and the left renal artery was taken with an aortic patch. Reconstruction of the pancreatic vessels was performed with a double anastomosis: the portal vein was anastomosed to the hole in the IVC resulting from the section of the left renal vein and the splenic artery was anastomosed to the hole in the aorta resulting from the section of the left renal artery. The proximal ends of the aorta and IVC were closed with running sutures. In the recipient, the iliac vessels on the right side were dissected. Anastomosis of the distal part of the aorta and the IVC was performed with the right iliac vessels. Duodenocystostomy and reimplantation of the ureter were done according to the usual techniques. This new surgical technique allowed an easy vascular reconstruction of the pancreatic vessels. In the recipient, only one side was used for renal and pancreatic transplantation. Moreover, the length of the transplant procedure was significantly reduced.
我们为两名患者设计并实施了一种新的整块肾脏和胰腺移植手术。在供体中，肝脏、胰腺和肾脏被整块切除。在手术台上，将肝脏和左肾从整块组织中分离出来，留下胰腺和右肾用于联合肾脏和胰腺移植。门静脉在脾静脉出现处附近切断。腹腔干连同一块主动脉补片一起取下。左肾静脉在其汇入下腔静脉（IVC）处切断，左肾动脉连同一块主动脉补片一起取下。胰腺血管的重建通过双重吻合进行：门静脉与因切断左肾静脉而在IVC上形成的孔进行吻合，脾动脉与因切断左肾动脉而在主动脉上形成的孔进行吻合。主动脉和IVC的近端用连续缝合线缝合。在受体中，解剖右侧的髂血管。将主动脉和IVC的远端与右侧髂血管进行吻合。十二指肠囊肿造口术和输尿管再植术按照常规技术进行。这种新的手术技术使胰腺血管的血管重建变得容易。在受体中，仅一侧用于肾脏和胰腺移植。此外，移植手术的时间显著缩短。
