Königsrainer A, Margreiter R, Schmid T, Steiner E, Bösmüller C, Spielberger M, Aigner F
Abteilung für Transplantationschirurgie, I. Universitätsklinik für Chirurgie Innsbruck.
Zentralbl Chir. 1990;115(12):757-65.
Between 1979 and December 1987 a total of 50 pancreas transplants were performed, 41 of them together with a kidney from the same donor. End-stage diabetic nephropathy was the indication for the combined procedure, and progressive pre-proliferative retinopathy for a single pancreas transplant. A segment consisting of body, tail but also major parts of the head of the gland was used. Technique-related complications or prolonged hospitalization prompted three changes in surgical technique. In the first five patients the pancreatic duct was occluded at the time of transplantation and in the subsequent eleven cases the graft was anastomosed to a Roux-Y-loop of jejunum. In a series of 17 patients thereafter the pancreatic duct was occluded after stabilization of graft function, and in the most recent 17 patients the pancreatic juice was drained into the urinary bladder. Prophylactic immunosuppression consisted of steroids and azathioprine for the first two patients. From 1981 to 1986 cyclosporin and prednisolone were given and from then on azathioprine was added as a third drug. Patient survival at one year was 25% in the first group, 80% in group II, 97% in group III and 88% in group IV. Cardiovascular and septic complications were the main causes of death. None of the group I transplants functioned at one year. Graft survival rates at one year for the pancreas and the kidney in groups II, III and IV were calculated at 30%, 70%, 58.8% and 77%, 86%, 72% respectively. In 16% of the long-term survivors significant amelioration and in another 50% stabilization of diabetic retinopathy occurred.
1979年至1987年12月期间，共进行了50例胰腺移植手术，其中41例同时移植了来自同一供体的肾脏。终末期糖尿病肾病是联合手术的适应症，而单纯胰腺移植的适应症是进行性增殖前期视网膜病变。移植所用的胰腺节段包括体部、尾部以及大部分头部。与技术相关的并发症或住院时间延长促使手术技术发生了三次改变。前五例患者在移植时结扎了胰管，随后的11例中，将移植物与空肠的Roux-Y袢进行了吻合。此后的17例患者中，在移植物功能稳定后结扎了胰管，而在最近的17例患者中，胰液被引流至膀胱。最初的两名患者预防性免疫抑制采用类固醇和硫唑嘌呤。1981年至1986年给予环孢素和泼尼松龙，此后添加硫唑嘌呤作为第三种药物。第一组患者一年的生存率为25%，第二组为80%，第三组为97%，第四组为88%。心血管和感染并发症是主要死因。第一组的移植无一在一年后仍有功能。第二、三、四组胰腺和肾脏一年的移植物存活率分别计算为30%、70%、58.8%和77%、86%、72%。16%的长期存活者糖尿病视网膜病变显著改善，另有50%病情稳定。
