Duffas J P
Service de Chirurgie Générale et Digestive, Hôpital Rangueil, Toulouse.
J Chir (Paris). 2004 Jul;141(4):213-24. doi: 10.1016/s0021-7697(04)95597-4.
Since the first pancreatic allograft in 1966, pancreatic transplantations have been performed by numerous surgical teams throughout the world. Initial results were disappointing with a high percentage of technical failures and rejection. Over-optimistic enthusiasm for islet-cell allografts also retarded the development of pancreatic transplantation. Despite this slow start, results of pancreatic transplantation from 1995 onward have been very satisfactory and equivalent to or even better than the results of other solid organ transplants. This success has been due to better graft selection, improved surgical techniques and preservation solutions, and especially to improvements in immunosuppressive protocols. More than 19,000 pancreatic transplantations have now been performed throughout the world including both combined kidney-pancreas transplantations and pancreas-only transplantations. The most satisfactory results occur in the setting of dialysis-dependent renal failure due to diabetes; simultaneous combined kidney and pancreas transplantation is performed with the total pancreas implanted into the bowel and with venous drainage into the portal system. The long-term risks and constraints of chronic diabetes with renal failure must be weighed against the risks of a complex surgical procedure, significant post-operative complications, and the need for long-term immunosuppressive therapy.
自1966年首例胰腺移植以来，世界各地的众多外科团队都开展了胰腺移植手术。最初的结果令人失望，技术失败和排斥反应的比例很高。对胰岛细胞同种异体移植过度乐观的热情也阻碍了胰腺移植的发展。尽管起步缓慢，但1995年以后的胰腺移植结果非常令人满意，与其他实体器官移植的结果相当，甚至更好。这一成功归功于更好的移植物选择、改进的手术技术和保存液，尤其是免疫抑制方案的改进。目前，全世界已进行了超过19000例胰腺移植手术，包括肾胰联合移植和单纯胰腺移植。最令人满意的结果出现在因糖尿病导致依赖透析的肾衰竭患者中；同时进行肾胰联合移植时，将整个胰腺植入肠道，并将静脉血引流至门静脉系统。必须权衡慢性糖尿病伴肾衰竭的长期风险和限制与复杂手术过程的风险、严重的术后并发症以及长期免疫抑制治疗的必要性。
