Kave Ben, Yii Ming, Bell Roger, Kanellis John, Scott David, Saunder Alan
Monash University Department of Surgery, Monash Medical Centre, Victoria, Australia.
ANZ J Surg. 2010 Oct;80(10):722-7. doi: 10.1111/j.1445-2197.2009.05083.x.
Pancreas-kidney transplantation is currently the most effective method to re-establish euglycaemia in insulin-dependent diabetics with associated renal failure. The standard technique employed has been bladder drainage of exocrine secretions coupled with systemic venous drainage ('systemic-bladder' (SB) drainage). The more physiological technique, enteric exocrine with portal venous drainage ('portal-enteric' (PE) drainage), has been utilized sparingly in the past as a result of fears of technical complications. This paper compares the Monash Medical Centre experience with both techniques.
A total of 68 simultaneous pancreas-kidney transplantations were performed at Monash Medical Centre from 1991 until 2004. The first 37 received SB drainage. Since March 2001, 27 have received PE drainage. This retrospective study compared the SB group (n= 37) with the PE group (n= 27), with a 2-year follow-up, examining a number of surgical outcomes.
Two-year patient (94.3 versus 96.0%), kidney (89.2 versus 85.2%), pancreas (77.9 versus 71.4%) and event-free (73.0 versus 67.7%) survivals were all similar between the SB and PE groups, respectively. Although surgery took longer in PE subjects (4 h : 47 min ± 0:48 versus 5 h : 16 min ± 1:00; P= 0.045), less intraoperative transfusions were required (1.3 ± 1.43 versus 0.52 ± 0.90; P= 0.024). Length of hospital stay and time to insulin independence were similar. Pancreas graft thrombosis rates were similar (10.8% SB versus 7.4% PE, P= 0.497).
PE drainage is a safe and viable method for pancreas transplantation, which can be performed with excellent outcomes. An increased rate of complications with PE drainage has not been demonstrated in this series.
胰肾联合移植是目前为伴有肾衰竭的胰岛素依赖型糖尿病患者重建正常血糖水平的最有效方法。采用的标准技术是外分泌液经膀胱引流并结合体静脉引流（“体静脉 - 膀胱”（SB）引流）。过去，由于担心技术并发症，生理上更为合理的技术，即外分泌液经肠道引流并结合门静脉引流（“门静脉 - 肠道”（PE）引流），使用较少。本文比较了莫纳什医疗中心采用这两种技术的经验。
1991年至2004年期间，莫纳什医疗中心共进行了68例胰肾联合移植手术。前37例接受SB引流。自2001年3月起，27例接受PE引流。这项回顾性研究将SB组（n = 37）与PE组（n = 27）进行比较，随访2年，检查了多项手术结果。
SB组和PE组的2年患者生存率（分别为94.3%对96.0%）、肾脏生存率（89.2%对85.2%）、胰腺生存率（77.9%对71.4%）和无事件生存率（73.0%对67.7%）均相似。虽然PE组患者的手术时间更长（4小时47分钟±0:48对5小时16分钟±1:00；P = 0.045），但术中输血需求更少（1.3±1.43对0.52±0.90；P = 0.024）。住院时间和胰岛素停用时间相似。胰腺移植血栓形成率相似（SB组为10.8%，PE组为7.4%，P = 0.497）。
PE引流是一种安全可行的胰腺移植方法，可取得优异的手术效果。本系列研究未证明PE引流并发症发生率增加。
