Boggi U, Vistoli F, Signori S, Del Chiaro M, Amorese G, Vanadia Bartolo T, Croce C, Sgambelluri F, Marchetti P, Mosca F
Division of Surgery in Uremic and Diabetic Patients, Department of Oncology, Transplants and Advanced Technologies in Medicine, University of Pisa, Pisa, Italy.
Transplant Proc. 2005 Jul-Aug;37(6):2648-50. doi: 10.1016/j.transproceed.2005.06.081.
We have recently described a technique for retroperitoneal pancreas transplantation (RPTx) with portal-enteric drainage (PED). Further experience with 118 RPTx is detailed herein.
Between April 2001 and August 2004, 118 patients underwent RPTx with PED among 125 recipients (94.4%) scheduled for this procedure. Surgical complications and patient and graft survivals were recorded prospectively.
After a minimum follow-up period of 3 months (mean 27.8 +/- 13.0 months), 18 recipients (15.2%) required relaparotomy because of bleeding (n = 6; 5.1%), allograft pancreatectomy due to either hyperacute/accelerated rejection (n = 3; 2.5%) or vein thrombosis (n = 3; 2.5%), leak from duodenojejunal anastomosis (n = 2; 1.7%), bleeding and vein thrombectomy (n = 1; 0.8%), or small bowel occlusion due to bezoar (n = 1; 0.8%). One patient had a negative relaparotomy and one underwent two relaparotomies. Most patients with hemorrhage (5/7; 71.4%) were recipients of solitary pancreas grafts managed with heparin infusion. No venous thrombi extended into recipient's superior mesenteric vein. Nonocclusive venous thrombosis was diagnosed with duplex ultrasonography and confirmed at computed tomography in seven patients (5.1%). None of these patients lost graft function. Ten patients (8.5%) were diagnosed with peripancreatic fluid collections, all successfully treated by observation (n = 7) or percutaneous drainage (n = 3). Enteric bleeding occurred in eight recipients (6.8%). Overall, 1-year patient and pancreas survival rates were 97.4% and 92.0%, respectively.
We conclude that RPTx with PED is a technical option that may be included in the repertoire of pancreas transplant surgeons.
我们最近描述了一种采用门静脉-肠内引流术（PED）进行腹膜后胰腺移植（RPTx）的技术。本文详细介绍了118例RPTx的更多经验。
在2001年4月至2004年8月期间，125例计划接受该手术的受者中有118例（94.4%）接受了采用PED的RPTx。前瞻性记录手术并发症以及患者和移植物的存活情况。
在最短随访期3个月（平均27.8±13.0个月）后，18例受者（15.2%）因出血（n = 6；5.1%）、超急性/加速性排斥反应（n = 3；2.5%）或静脉血栓形成（n = 3；2.5%）行同种异体胰腺切除术、十二指肠空肠吻合口漏（n = 2；1.7%）、出血和静脉血栓切除术（n = 1；0.8%）或因粪石导致小肠梗阻（n = 1；0.8%）而需要再次剖腹手术。1例患者再次剖腹手术未发现异常，1例患者接受了两次再次剖腹手术。大多数出血患者（5/7；71.4%）是接受单独胰腺移植并接受肝素输注治疗的受者。没有静脉血栓延伸至受者的肠系膜上静脉。7例患者（5.1%）经双功超声诊断为非闭塞性静脉血栓形成，并经计算机断层扫描证实。这些患者均未丧失移植物功能。10例患者（8.5%）被诊断为胰周积液，均通过观察（n = 7）或经皮引流（n = 3）成功治疗。8例受者（6.8%）发生肠出血。总体而言，1年患者和胰腺存活率分别为97.4%和92.0%。
我们得出结论，采用PED的RPTx是一种技术选择，可纳入胰腺移植外科医生的技术储备中。
