Sindhi R, Stratta R J, Lowell J A, Sudan D, Cushing K A, Castaldo P, Jerius J T
Department of Surgery, Medical University of South Carolina, Charleston, USA.
J Am Coll Surg. 1997 Mar;184(3):281-9.
Bladder drainage by the duodenal segment technique is currently the preferred method of handling the exocrine secretions after vascularized pancreatic transplantation. Despite improving results, however, the management of metabolic and urologic complications associated with bladder drainage remains problematic.
A retrospective survey was performed of a consecutive case series of 196 pancreatic transplantations in 186 patients with diabetes over an 80-month period. All patients underwent whole organ pancreatic transplantation with bladder drainage by the duodenal segment technique.
A total of 25 conversions (13 percent) from bladder drainage to enteric drainage were performed in 24 patients (24 side-to-side duodenoenterostomies, one Roux-en-Y limb duodenoenterostomy). The mean time of enteric conversion after pancreatic transplantation was 22 +/- 18 months (range, 1 to 72 months). All but two of the enteric conversions were performed at least 6 months after pancreatic transplantation. Indications for enteric conversion included dehydration with intractable metabolic acidosis (n = 18; 9 percent), urologic complications (n = 5; 3 percent), or problems with the duodenal segment (n = 2; 1 percent). The mean length of hospitalization for enteric conversion was 12 +/- 7 days (range, 6 to 30 days). All patients experienced improvement in their symptoms after enteric conversion. Anastomotic leaks developed postoperatively in five patients; two were managed operatively and three were managed nonoperatively. Oral bicarbonate supplementation was eliminated in all but one patient after enteric conversion. Patient survival is 100 percent and pancreatic graft survival (insulin independence) is 96 percent after a mean follow-up of 22 months after enteric conversion.
Enteric conversion after pancreatic transplantation with bladder drainage is a safe and effective therapy for refractory problems related to the duodenal segment, altered physiologic function, or urologic complications and should be considered after 6 months for patients with persistent side effects.
十二指肠段技术进行膀胱引流是目前血管化胰腺移植后处理外分泌的首选方法。然而，尽管效果有所改善，但与膀胱引流相关的代谢和泌尿系统并发症的管理仍然存在问题。
对186例糖尿病患者在80个月内连续进行的196例胰腺移植病例系列进行回顾性调查。所有患者均采用十二指肠段技术进行全器官胰腺移植并膀胱引流。
24例患者（24例侧侧十二指肠空肠吻合术，1例Roux-en-Y型十二指肠空肠吻合术）共进行了25次从膀胱引流转为肠道引流的转换（13%）。胰腺移植后肠道转换的平均时间为22±18个月（范围1至72个月）。除2例肠道转换外，其余均在胰腺移植后至少6个月进行。肠道转换的指征包括伴有难治性代谢性酸中毒的脱水（n = 18；9%）、泌尿系统并发症（n = 5；3%）或十二指肠段问题（n = 2；1%）。肠道转换的平均住院时间为12±7天（范围6至30天）。所有患者在肠道转换后症状均有改善。术后5例患者出现吻合口漏；2例接受手术治疗，3例接受非手术治疗。肠道转换后除1例患者外，所有患者均停止口服碳酸氢盐补充。肠道转换后平均随访22个月，患者生存率为100%，胰腺移植存活率（无需胰岛素）为96%。
膀胱引流胰腺移植后进行肠道转换是治疗与十二指肠段、生理功能改变或泌尿系统并发症相关的难治性问题的安全有效方法，对于有持续副作用的患者应在6个月后考虑。
