Martin X, Dubernard J M, Sanseverino R, Melandri M, Faure J L, Camozzi L, LeFrancois N, La Rocca E, Gelet A
Service d'Urologie et de chirurgie de la transplantation, E. Herriot Hospital, Lyon, France.
Diabetes. 1989 Jan;38 Suppl 1:16-7. doi: 10.2337/diab.38.1.s16.
Between January 1985 and September 1987, we performed a prospective comparative study between segmental-pancreas transplantation with duct obstruction by neoprene (n = 17) and pancreaticoduodenal transplantation with enteric diversion to a Roux-en-Y intestinal loop (n = 14). All recipients had insulin-dependent diabetes. The immunosuppressive protocol consisted of low doses of the steroids cyclosporin A and azathioprine. Mean follow-up was 16.5 mo for the enteric-diversion group and 13.5 mo for duct-obstructed groups. Two-year patient and pancreas- and kidney-graft actuarial survival rates were 92.9, 75.5, and 74.2%, respectively, in the former group and 92.3, 58.4, and 63.7%, respectively, in the latter group (NS). Five whole-organ grafts were lost (3 vascular thromboses, 1 pancreatitis, 1 rejection), and four segmental grafts were lost (2 vascular thromboses, 1 bleeding, 1 patient's death with functional graft). More surgical complications occurred in the recipients of whole-organ grafts and were often related to the intestinal anastomosis. A satisfactory blood glucose control was observed at 3 mo and 1 yr in both groups. Provocative tests showed higher and prompter insulin secretion in patients with whole-organ grafts. In patients with segmental grafts, the response was lower and delayed with a general tendency to impaired glucose tolerance. A marked hyperinsulinemia after meals was observed in whole-organ graft recipients. Slight nocturnal hyperinsulinemia was observed in both groups. At 1 yr, glycosylated hemoglobin was normal in both groups. The absence of a significant difference between the two groups, in terms of survival and graft function, and the lower surgical complication rate seen with segmental grafts have made us return to neoprene-injected segmental grafts.
1985年1月至1987年9月期间，我们对17例采用氯丁橡胶造成导管阻塞的节段性胰腺移植与14例将肠道改道至Roux-en-Y肠袢的胰十二指肠移植进行了前瞻性对照研究。所有受者均为胰岛素依赖型糖尿病患者。免疫抑制方案包括低剂量的类固醇、环孢素A和硫唑嘌呤。肠改道组的平均随访时间为16.5个月，导管阻塞组为13.5个月。前一组的2年患者、胰腺和肾移植精算生存率分别为92.9%、75.5%和74.2%，后一组分别为92.3%、58.4%和63.7%（无显著性差异）。5例全器官移植失败（3例血管血栓形成、1例胰腺炎、1例排斥反应），4例节段性移植失败（2例血管血栓形成、1例出血、1例患者死亡但移植器官仍有功能）。全器官移植受者发生的手术并发症更多，且常与肠道吻合有关。两组在术后3个月和1年时血糖控制均令人满意。激发试验显示，全器官移植患者的胰岛素分泌更高且更迅速。节段性移植患者的反应较低且延迟，总体上有糖耐量受损的趋势。全器官移植受者餐后出现明显的高胰岛素血症。两组均观察到轻微的夜间高胰岛素血症。1年时，两组糖化血红蛋白均正常。两组在生存和移植功能方面无显著差异，且节段性移植的手术并发症发生率较低，这使我们重新采用注射氯丁橡胶的节段性移植。
