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胰腺移植不断发展的手术策略

Evolving surgical strategies for pancreas transplantation.

作者信息

Leeser David B, Bartlett Stephen T

机构信息

University of Maryland Medical School, Department of Surgery, Division of Transplantation, 29 South Greene Street, Suite 200, Baltimore, MD 21201, USA.

出版信息

Curr Diab Rep. 2004 Aug;4(4):310-5. doi: 10.1007/s11892-004-0084-7.

Abstract

Pancreas transplant has become a reliably predictable treatment and cure for patients with type 1 diabetes mellitus and hypoglycemic unawareness or renal failure. During the past 2 years, the use of enteric drainage has been shown to decrease morbidity over traditional bladder drainage, and the use of the portal system for venous drainage continues to be explored. Technically, the use of circular staplers, over a hand-sown anastomosis for duodenal drainage, has gained popularity, and alternative arterial reconstruction methods have been developed. Living donor pancreas and kidney transplants are also becoming more common throughout the world. In the area of immunosuppression, steroid-free protocols, now commonplace in kidney transplants, are being applied successfully to pancreas transplantation. Finally, the benefit of solitary pancreas and pancreas after kidney transplantation has been questioned, and a more complete analysis of pancreas alone and pancreas after kidney transplants is anticipated in the near future.

摘要

胰腺移植已成为治疗1型糖尿病合并低血糖无知觉或肾衰竭患者的一种可靠且可预测的疗法。在过去两年中,与传统膀胱引流相比,肠内引流的应用已显示出可降低发病率,并且门静脉系统用于静脉引流的应用仍在探索中。从技术上讲,使用圆形吻合器进行十二指肠引流而非手工缝合吻合术已越来越普遍,并且已开发出替代的动脉重建方法。活体供体胰腺和肾脏移植在全球也越来越普遍。在免疫抑制领域,目前在肾脏移植中常见的无类固醇方案已成功应用于胰腺移植。最后,单独胰腺移植和肾后胰腺移植的益处受到质疑,预计在不久的将来会对单独胰腺移植和肾后胰腺移植进行更全面的分析。

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