Kuo P C, Johnson L B, Schweitzer E J, Bartlett S T
Department of Surgery, University of Maryland Medical System, Baltimore 21201, USA.
Transplantation. 1997 Jan 27;63(2):238-43. doi: 10.1097/00007890-199701270-00011.
Simultaneous pancreas/kidney transplantation (SPK) has evolved to become a therapeutic option for patients with renal failure resulting from type 1 diabetes mellitus. However, the appropriate route for drainage of the exocrine secretions of the pancreas allograft remains unclear. While bladder drainage (BD) is the current state of the art, it is associated with a high frequency of urologic complications, including urinary tract infections, hematuria, metabolic acidosis, dehydration, and reflux pancreatitis. Although enteric drainage (ED) is the more physiologic route, it has been associated in the past with decreased graft survival and increased infectious complications. In addition, BD offered a technique for detection of rejection through measurement of urinary amylase. However, with the advent of improved immunosuppression and antibiotic therapy, percutaneous pancreas biopsy, improved radiologic imaging, and greater understanding of pancreas transplantation, we hypothesized that ED could be performed without increased morbidity or cost. A group of 23 consecutive SPK was performed with ED during the period from July 1995 to November 1995. Another 23 age- and sex-matched recipients of SPK with BD performed from November 1994 to June 1995 served as a historical control group. Because of the differing lengths of follow-up, data were analyzed with respect to the first six months posttransplant. ED and BD were associated with equivalent actuarial one-year patient and graft survival rates: 100% and 88% for ED, and 96% and 91% for BD, respectively. Hospital charges, length of stay, readmissions, rejection, sepsis-related procedures were also equivalent in ED and BD. However, ED was associated with significantly fewer urinary tract infections and urologic complications. In addition, no grafts were lost as the result of sepsis. In the setting of SPK, ED represents a viable alternative to BD for primary drainage of pancreas exocrine secretions. Further studies with extended lengths of follow-up are necessary to confirm our observations.
同时进行胰腺/肾脏移植（SPK）已发展成为1型糖尿病所致肾衰竭患者的一种治疗选择。然而，胰腺移植异体的外分泌引流的合适途径仍不明确。虽然膀胱引流（BD）是目前的最佳方法，但它与泌尿系统并发症的高发生率相关，包括尿路感染、血尿、代谢性酸中毒、脱水和反流性胰腺炎。尽管肠道引流（ED）是更符合生理的途径，但过去它与移植存活率降低和感染并发症增加有关。此外，BD提供了一种通过测量尿淀粉酶来检测排斥反应的技术。然而，随着免疫抑制和抗生素治疗的改进、经皮胰腺活检、放射影像学的改善以及对胰腺移植的更深入了解，我们推测可以在不增加发病率或成本的情况下进行ED。1995年7月至1995年11月期间，对一组连续的23例SPK患者进行了ED。另一组23例年龄和性别匹配的接受BD的SPK受者，于1994年11月至1995年6月进行手术，作为历史对照组。由于随访时间不同，对移植后前六个月的数据进行了分析。ED和BD的1年实际患者和移植存活率相当：ED分别为100%和88%，BD分别为96%和91%。ED和BD在医院费用、住院时间、再次入院、排斥反应、脓毒症相关程序方面也相当。然而，ED与明显更少的尿路感染和泌尿系统并发症相关。此外，没有移植物因脓毒症而丢失。在SPK的情况下，ED是胰腺外分泌引流的主要方式，是BD的可行替代方案。需要进行更长随访时间的进一步研究来证实我们的观察结果。
