Fang J L, Guo Y H, Ma J J, Li G H, Zhang L, Xu L, Yin W, Lai X X, Zhang Y R, Liu L H, Xiong Y Y, Li L, Chen R X, Zhang T, Zhang P, Xu H L, Wan J, Wu J L, Pan G H, Chen Z, Shi B Y
Organ Transplant Center, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 510260, China.
Department of Organ Transplantation Institute, the 8th Medical Center, Chinese PLA General Hospital, Beijing 100091, China.
Zhonghua Yi Xue Za Zhi. 2020 Dec 29;100(48):3853-3858. doi: 10.3760/cma.j.cn112137-20200924-02704.
To investigate the clinical effect of ipsilateral simultaneous pancreas and kidney transplantation (SPK). A total of 146 cases of SPK surgeries completed in the Second Affiliated Hospital of Guangzhou Medical University from September 2016 to June 2020 were selected to summarize the outcome, curative effect and complications of the operation. The patients were followed up for 1 to 45 months. Good clinical results were obtained in 146 patients. Renal function indicators suggest that on the 7th day after operation, the serum creatinine returned to normal level [142.4 (108.6, 213.4)μmol/L]. The index of pancreatic function decreased to the normal level as expected. The level of blood amylase was 160.5(109.3, 249.8) U/L within 7 days after operation, and then decreased. The trend of urinary amylase was similar to that of blood amylase, which was 240(121.0, 370.0) U/L 7 days after operation, and glycosylated hemoglobin decreased to the normal level (5.8%±1.4%) 1 month after operation. The main medical complications were infection including pulmonary infection (26.03%, 38/146), urinary tract infection (26.03%,38/146), and abdominal infection (4.79%,7/146), acute rejection including renal graft rejection (5.8%,8/146), pancreas/duodenum rejection (18.49%,27/146), and renal graft combined pancreatic graft rejeciton (6.85%,10/146), as well as gastrointestinal bleeding (30.82%,45/146), of which 5 cases were severe bleeding (3.42%, 5/146). The main surgical complications were poor incision healing (10.27%, 15/146), serious surgical complications including arteriovenous thrombosis of the transplanted pancreas (2.05%, 3/146) and intestinal leakage (0.68%,1/146). The 1-year and 3-year patient, renal and pancreatic survival rates were both 92.5%, 91.5% and 89.5%, respectively, and despite the death, the 1-year, 3-year transplanted kidney survival rate was both 99.3%, and 95% for the the 1-year, 3-year pancreas survival rate. Strict preoperative evaluation of the function of large organs, reasonable surgical methods, perioperative anticoagulation, and prompt diagnosis of complications can achieve good clinical results for patients with SPK.
探讨同期胰肾联合移植（SPK）的临床效果。选取2016年9月至2020年6月在广州医科大学附属第二医院完成的146例SPK手术病例，总结手术的转归、疗效及并发症。对患者进行1至45个月的随访。146例患者均取得了良好的临床效果。肾功能指标显示，术后第7天血清肌酐恢复至正常水平[142.4（108.6，213.4）μmol/L]。胰腺功能指标如预期降至正常水平。术后7天内血淀粉酶水平为160.5（109.3，249.8）U/L，随后下降。尿淀粉酶变化趋势与血淀粉酶相似，术后7天为240（121.0，370.0）U/L，糖化血红蛋白术后1个月降至正常水平（5.8%±1.4%）。主要医学并发症包括感染，其中肺部感染（26.03%，38/146）、泌尿系统感染（26.03%，38/146）、腹腔感染（4.79%，7/146）；急性排斥反应包括肾移植排斥（5.8%，8/146）、胰腺/十二指肠排斥（18.49%，27/146）、肾移植合并胰腺移植排斥（6.85%，10/146），以及消化道出血（30.82%，45/146），其中5例为严重出血（3.42%，5/146）。主要手术并发症包括切口愈合不良（10.27%，15/146），严重手术并发症包括移植胰腺动静脉血栓形成（2.05%，3/146）和肠漏（0.68%，1/146）。患者、肾和胰腺的1年及3年生存率分别为92.5%、91.5%和89.5%，尽管有死亡病例，但移植肾的1年、3年生存率均为99.3%，移植胰腺的1年、3年生存率为95%。对大器官功能进行严格的术前评估、采用合理的手术方式、围手术期抗凝以及及时诊断并发症，可为SPK患者取得良好的临床效果。
