Friedrich J, Charpentier K, Marsh C L, Bakthavatsalam R, Levy A E, Kuhr C S
Division of Transplantation, Departments of Surgery and Urology, University of Washington, Seattle, Washington 98195, USA.
Transplant Proc. 2004 Dec;36(10):3101-4. doi: 10.1016/j.transproceed.2004.11.007.
Bladder drainage of the exocrine secretions of pancreas transplants has been the standard of practice as it affords the ability to monitor for rejection and is thought to be associated with decreased morbidity. Recently, there has been renewed interest in avoiding the urinary tract complications and metabolic derangements that accompany bladder drainage by draining pancreatic exocrine secretions into the jejunum (enteric drainage). We sought to determine whether enteric drainage of pancreas transplants is safe and offers advantages without compromise in graft function or longevity.
We retrospectively reviewed all pancreas transplants performed at the University of Washington between 2000 and 2003. Selection of the exocrine drainage method was based on the length of cold ischemia time and whether the pancreas was transplanted alone or in combination with a kidney. Pearson's chi-square and Fisher's Exact tests were used for statistical comparisons in complications or rejections between the groups.
Thirty-four pancreas transplants were performed with exocrine drainage into the bladder used in 17 and enteric drainage in 17. The complication rate was 53% in the bladder-drained group and 41% (P=.49) in the enteric-drained group. The incidence of pancreas rejection was 24% in the bladder-drained versus 29% in the enteric-drained patients (P=.50). One graft failed, which was in the bladder cohort.
We found comparable rejection and complication rates between groups. We conclude that enteric drainage is safe when used selectively, and entails no increased risks compared with bladder drainage.
胰腺移植外分泌液的膀胱引流一直是标准的做法，因为它能够监测排斥反应，并且被认为与发病率降低有关。最近，人们重新关注通过将胰腺外分泌液引流至空肠（肠内引流）来避免膀胱引流所伴随的泌尿系统并发症和代谢紊乱。我们试图确定胰腺移植的肠内引流是否安全，并且在不损害移植物功能或寿命的情况下是否具有优势。
我们回顾性分析了2000年至2003年在华盛顿大学进行的所有胰腺移植手术。外分泌液引流方法的选择基于冷缺血时间的长短以及胰腺是单独移植还是与肾脏联合移植。使用Pearson卡方检验和Fisher精确检验对两组之间的并发症或排斥反应进行统计学比较。
共进行了34例胰腺移植手术，其中17例采用膀胱引流外分泌液，17例采用肠内引流。膀胱引流组的并发症发生率为53%，肠内引流组为41%（P = 0.49）。膀胱引流患者的胰腺排斥发生率为24%，肠内引流患者为29%（P = 0.50）。有1例移植物失败，发生在膀胱引流组。
我们发现两组之间的排斥反应和并发症发生率相当。我们得出结论，选择性使用肠内引流是安全的，与膀胱引流相比没有增加风险。
