Abstract:

Objective To summarize and analyze the clinical efficacy of simultaneous pancreaskidney transplantation（SPK）with different drainage methods in 53 patients with diabetic nephropathy. MethodsFrom May 2010 to December 2019, 53 simultaneous pancreas-kidney transplantation surgeries were completed at theTransplant Medical Center of The Second Affiliated Hospital of Guangxi Medical University. There were 22 cases in pancreatic fluid bladder drainage（BD）surgery group and 31 cases in pancreatic fluid jejunal drainage（ED）surgery group.The patients were treated with anti lymphocyte globulin or anti-CD25 monoclonal antibody during the operation，andtacrolimus，mycophenolate mofetil and glucocorticoid triple immunosuppressive regimen were used in the early stage. The 1-year survival rate，delayed recovery of pancreas function，incidence of delayed renal function recovery（DGF），operation time，pancreatic cold ischemia time，reoperation rate，intraoperative total blood transfusion，blood glucosechange trend inone month after operation，and other complications were compared between the two groups. Results A total number of 53 cases were operated successfully. All patients were followed up for 2 to 60 months. Among them，22 cases were performedwith pancreatic juice bladder drainage（BD）. One patient developed necrotizing pancreatitis，and the pancreas was resected. After 6 months，pancreas transplantation was successful. Three recipients had delayed recovery of renal allograft functionafter operation. One patient had delayed recovery of renal function. Bladder mucosal bleeding occurred after urination recovery. After three times of interventional embolization，pulmonary infection occurred and the patient died. Pancreatic andrenal functions were normal at the time of death. The rest of the patients survived and their fasting blood glucose returned to normal at（14.2 ± 5.1）d，（9.5 ± 4.2）d after surgery，and serum creatinine returned to normal after（10.4 ± 6.5）d. The average length of hospital stay was（21.4±7.3）d. Postoperative complications included 1 case of pancreatic incision infectionand 1 case of lymphatic leakage. Other complications included 1 case of urinary tract infection，2 cases of pancreatic vein thrombosis，1 case of tacrolimus poisoning and 1 case of acute rejection of transplanted kidney. Eleven patients were cured and discharged. In addition，31 cases recieved pancreatic juice jejunal drainage（ED）operation，fasting blood glucose returned to normal on（12.2 ± 5.1）d after operation，（7.3 ± 3.2）d after operation，and serum creatinine returned to normal after（11.2 ± 5.7）d. The average hospital stay was（18.6 ± 6.6）d. Two patients experienced postoperative thrombosis of transplanted pancreatic veins and underwent pancreatic resection. Two patients developed necrotizing pancreatitis and underwent pancreatic resection. Postoperative complications included pancreatic incision infection in 2 cases，lymphatic leakage in 2 cases，tacrolimus poisoning in 1case andacuterejection in2 cases. Thirty-one patients were cured and discharged. Conclusion Thesurvival rate of recipientsand grafts was not affected，andthe qualityof life of patients was higher than that of bladder drainage group. The application of donor organ function protection system and meticulous and individualized perioperative treatment plan can improve the efficacy and safety of pancreatico jejunal drainage. It isworthyof clinical promotion. 

Key words:

Simultaneous pancreas kidney transplantation, Pancreatic fluid drainage method, Clinical efficacy

摘要：

目的 分析 53 例糖尿病并终末期肾病患者行同期胰肾联合移植不同胰液引流术式的临床效果对比。 方法 2010 年 5 月至 2019 年 12 月广西医科大学第二附属医院移植医学中心完成了 53 例同期胰肾联合移植手术，其中胰液膀胱引流（bladder drainage，BD）术式 22 例，胰液空肠引流（enteric drainage，ED）术式组 31 例。对比两组不同胰液引流术式受者的移植肾功能延迟恢复发生率、术后移植胰腺功能延迟恢复发生率、胰腺冷缺血时间、移植胰腺 1 年生存率、手术时间、再手术率、术中总输血量、术后 1 个月血糖变化、其他并发症等。 结果 53 例胰肾联合移植手术成功，随访 4 ～ 90 个月，在 22 例 BD 术式中，有 1 例患者发生坏死性胰腺炎，切除胰腺。3 例患者出现移植肾功能延迟恢复，有 1 例患者移植肾功能延迟恢复，恢复有尿后发生出血性膀胱炎，后并发肺部感染而死亡。移植后（14.2±5.1）d 空腹血糖降至正常，（9.5±4.2）d 停止使用胰岛素，（10.4±6.5）d 肾功能恢复正常。平均住院时间为（21.4±7.3）d，术后出现并发症有移植胰腺静脉血栓 2 例，泌尿系感染 1 例，移植胰淋巴漏 1 例，切口感染 1 例，他克莫司中毒 1 例、移植肾急性排斥反应 1 例。21 例患者长期存活。在 31 例 ED 术式组中，术后（12.2± 5.1）d 空腹血糖降至正常，（7.3±3.2）d停止使用胰岛素，（11.2±5.7）d 肾功能恢复正常。平均住院时间为（18.6± 6.6）d，2 例患者术后出现移植胰 腺静脉血栓形成，切除胰腺。2 例患者出现坏死性胰腺炎，切除胰腺。移植肾急性排斥反应（经活检证实）2 例，移植胰切口感染 2 例，他克莫司中毒 1 例。31 例患者长期长期存活。结论 胰肾联合移植胰液空肠引流术式组受者并没有增加手术风险，且受者及移植物存活率未受影响，患者生活质量高于膀胱引流组，胰肾联合移植手术胰液空肠引流术式的临床效果和安全性较好，临床上值得推广。 

关键词:

同期胰肾联合移植 , 胰液引流方式 , 临床疗效