Ploeg R J, Eckhoff D E, D'Alessandro A M, Stegall M D, Knechtle S J, Pirsch J D, Sollinger H W, Belzer F O
Department of Surgery, University of Groningen, The Netherlands.
Transplant Proc. 1994 Apr;26(2):458-9.
In summary, we feel that excellent 5-year patient and graft survival results can be obtained using SPK transplantation with bladder drainage technique. Despite the good results, a significant morbidity with prolonged hospitalization is seen after pancreas transplantation. This increased morbidity is due to infectious complications, rejection and urological complications. As a result of the popularity of bladder drainage, the complications after pancreas transplantation have shifted from intraabdominal to urological. Enteric conversion after SPK transplantation is the treatment of choice for chronic hematuria and a duodenal segment leak. In our hands this method appeared to be a safe and reliable procedure with a low complication rate. Enteric conversion should be considered in early leaks after failure of one attempt to suture repair the anastomotic site. In larger leaks or late leaks, it is advisable to perform an immediate enteric conversion. With the considerations above one might ask why enteric conversion is not our current primary choice for the initial transplant procedure. We have, however, noted a higher incidence of postoperative intraabdominal septic complications as well as mycotic aneurysms at the arterial suture line in a small series of 16 primarily enterically drained pancreas transplants. We also fear that the leakage rate after primary duodenoenteric drainage could be higher because of significant edema after transplantation in the preserved duodenal segment. We doubt, therefore, that the primary anastomosis with the bowel is as safe as one performed during enteric conversion when preservation injury has been resolved. At that point the patient is in stable condition and on significantly lower doses of immunosuppression than at the time of transplantation. This study demonstrates that urological complications constitute a major part of the morbidity after SPK transplantation. Despite this fact, appropriate treatment including enteric conversion can resolve most of the complications and prevent long-term morbidity or even graft loss.
总之，我们认为采用膀胱引流技术进行胰肾联合移植可获得出色的5年患者和移植物存活结果。尽管结果良好，但胰腺移植后仍可见到显著的发病率，并伴有住院时间延长。发病率增加是由于感染性并发症、排斥反应和泌尿系统并发症所致。由于膀胱引流的普及，胰腺移植后的并发症已从腹腔内并发症转变为泌尿系统并发症。胰肾联合移植后行肠道转流术是治疗慢性血尿和十二指肠段渗漏的首选方法。在我们的操作中，该方法似乎是一种安全可靠、并发症发生率低的手术。在尝试缝合修复吻合口失败后的早期渗漏中，应考虑进行肠道转流术。对于较大的渗漏或晚期渗漏，建议立即进行肠道转流术。基于上述考虑，有人可能会问为什么肠道转流术不是我们目前初始移植手术的首选方法。然而，我们注意到在一小系列16例主要采用肠道引流的胰腺移植中，术后腹腔内感染性并发症以及动脉缝合线处霉菌性动脉瘤的发生率较高。我们还担心，由于保留的十二指肠段在移植后出现明显水肿，初次十二指肠-肠道引流后的渗漏率可能会更高。因此，我们怀疑当保存损伤得到解决后，初次与肠道的吻合是否像在肠道转流术时那样安全。此时患者病情稳定，免疫抑制剂量比移植时显著降低。本研究表明，泌尿系统并发症是胰肾联合移植后发病率的主要组成部分。尽管如此，包括肠道转流术在内的适当治疗可以解决大多数并发症，并预防长期发病甚至移植物丢失。
