Karam Georges, Maillet Frédéric, Le Normand Loïc, Glemain Pascal, Drapier Eric, Bouchot Olivier, Cantarovich Diego
Clinique Urologique, CHU Hôtel-Dieu, Nantes, France.
Prog Urol. 2004 Feb;14(1):19-23.
The objective of this study was to evaluate the results and surgical complications of total pancreas transplantation with enteric exocrine drainage since the beginning of our experience with this type of transplantation.
From November 1999 to December 2002, 62 total pancreas transplantations were performed, consisting of 51 combined kidney-pancreas transplantations, 10 after renal transplantation and 1 pancreas-liver transplantation. Kidneys and pancreases were washed and stored in either Belzer solution or Celsior solution. Transplantation was performed via a midline transperitoneal incision with venous anastomosis at the root of the inferior vena cava (54 cases) or, more recently, in the superior mesenteric vein (8 cases). The arterial anastomosis was then performed in the right common iliac artery. Exocrine drainage was performed by side-to-side anastomosis between the donor duodenum and the recipient jejunum. The kidney was transplanted onto the left external iliac vessels and was extraperitonealised.
The mean age of the recipients and donors was 41 +/- 9 years and 33 +/- 11 years, respectively. The mean cold ischaemia time was 14 +/- 5 hours. Four pancreases were lost due to venous thrombosis, 1 due to severe pancreatitis with haemodynamic collapse and venous thrombosis and another due to total necrosis of the duodenum. Seventeen patients (27%) were reoperated, including 10 during the first postoperative month and 7 during the first year. No cases of fistula of the gastrointestinal anastomosis were observed. All patients with a functional graft no longer required exogenous insulin. The actuarial patient and graft three-year survival was 96% and 86% respectively.
Despite their high frequency, surgical complications did not have any harmful effects on either control of diabetes or graft and patient survival.
本研究的目的是评估自我们开展此类胰腺移植以来，采用肠内外分泌引流的全胰腺移植的结果及手术并发症。
1999年11月至2002年12月，共进行了62例全胰腺移植，其中包括51例肾 - 胰腺联合移植、10例肾移植术后胰腺移植和1例胰 - 肝移植。肾脏和胰腺用Belzer溶液或Celsior溶液冲洗并保存。移植通过中线经腹切口进行，静脉吻合于下腔静脉根部（54例），或最近在肠系膜上静脉进行（8例）。然后在右髂总动脉进行动脉吻合。外分泌引流通过供体十二指肠与受体空肠的侧 - 侧吻合进行。肾脏移植到左髂外血管上并置于腹膜外。
受体和供体的平均年龄分别为41±9岁和33±11岁。平均冷缺血时间为14±5小时。4例胰腺因静脉血栓形成丢失，1例因严重胰腺炎伴血流动力学衰竭和静脉血栓形成丢失，另1例因十二指肠完全坏死丢失。17例患者（27%）接受了再次手术，其中10例在术后第一个月内，7例在第一年内。未观察到胃肠吻合口瘘的病例。所有移植功能良好的患者不再需要外源性胰岛素。患者和移植物三年实际生存率分别为96%和86%。
尽管手术并发症发生率较高，但对糖尿病的控制或移植物及患者的生存均无有害影响。
