Ryu Je Ho, Lee Tae Beom, Park Young Mok, Yang Kwang Ho, Chu Chong Woo, Lee Jung Hee, Kim Taeun, Choi Byung Hyun
Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, South Korea.
Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea.
Ann Transplant. 2017 Jan 19;22:24-34. doi: 10.12659/aot.901469.
BACKGROUND The surgical technique used in pancreas transplant is essential for patient safety and graft survival, and problems exist with conventional strategies. When enteric exocrine drainage is performed, there is no method of immunologic monitoring other than direct graft pancreas biopsy. The most common cause of early graft failure is graft thrombosis, and adequate preventive and treatment strategies are unclear. To overcome these disadvantages, we suggest a modified surgical technique. MATERIAL AND METHODS Eleven patients underwent pancreas transplant with our modified technique. The modified surgical techniques are as follows: 1) graft duodenum was anastomosed with recipient duodenum to enable endoscopic immunological monitoring, and 2) the inferior vena cava was chosen for vascular anastomosis and a diamond-shaped patch was applied to prevent graft thrombosis. RESULTS No patient mortality or graft failure occurred. One case of partial thrombosis of the graft portal vein occurred, which did not affect graft condition, and resolved after heparin treatment. All patients were cured from diabetes mellitus. There were no cases of pancreatic rejection, but 2 cases of graft duodenal rejection occurred, which were adequately treated with steroid therapy. CONCLUSIONS This modified surgical technique for pancreas transplant represents a feasible method for preventing thrombosis and allows for direct graft monitoring through endoscopy.
背景 胰腺移植所采用的手术技术对患者安全和移植物存活至关重要，而传统策略存在问题。在进行肠道外分泌引流时，除了直接对移植胰腺进行活检外，没有其他免疫监测方法。早期移植物失败的最常见原因是移植物血栓形成，且充分的预防和治疗策略尚不清楚。为克服这些缺点，我们提出一种改良的手术技术。 材料与方法 11例患者采用我们改良的技术接受了胰腺移植。改良的手术技术如下：1）将移植十二指肠与受体十二指肠吻合，以便进行内镜免疫监测；2）选择下腔静脉进行血管吻合，并应用菱形补片预防移植物血栓形成。 结果 无患者死亡或移植物失败发生。发生1例移植门静脉部分血栓形成，未影响移植物状况，经肝素治疗后缓解。所有患者的糖尿病均治愈。无胰腺排斥反应病例，但发生2例移植十二指肠排斥反应，经类固醇治疗后得到充分治疗。 结论 这种改良的胰腺移植手术技术是预防血栓形成的可行方法，并允许通过内镜对移植物进行直接监测。
