【摘要】 目的　总结 1 0例胰液空肠引流 (ED)术式胰肾一期联合移植 (SPK)的外科技术和治疗胰岛素依赖型糖尿病(IDDM)合并尿毒症的效果。方法　 2 0 0 0年 6月至 2 0 0 3年 7月间完成改进的 ED术式 SPK1 0例 ,不做 Roux- en- Y吻合。免疫抑制治疗术后早期采用四联诱导治疗 (FK5 0 6 / Cs A+MMF+皮质激素 +AL G或抗 CD2 5单抗 ) ,以后改为三联维持。结果　 1 0例手术均获得成功 ,移植肾功能即刻恢复 ,除 1例移植胰功能延迟恢复外 ,余 9例术后 1周内血糖降至正常水平 ,完全停用外源性胰岛素。1例术后 6月带正常移植物功能死于心肌梗塞 ,4例存活已超过 1年 ;发生急性排斥反应 4例次 ,除 1例难治性排斥未能逆转行再次肾移植外 ,余 3例经激素冲击或 OKT3治疗均获好转。并发症情况 :出现腹腔感染与切口感染各 2例 ,肾周血肿 1例 ,分别经手术探查或引流换药治疗后愈合。结论　改进的 ED术式胰肾联合移植安全、简单 ,无严重外科并发症 ,是值得推广的治疗 IDDM合并尿毒症的理想方法更多还原

【Abstract】 Objective To summarize the results of simultaneous pancreatic kidney transplantation (SPK) with enteric drainage (ED) in the treatment of insulin dependent diabetes mellitus (IDDM) with uremia.Methods From June 2000 to July 2003, 10 cases of IDDM with uremia received SPK. The pancreatic allograft exocrine secretion was drained into the proximal jejunum via a side to side duodenojujunostomy (no Roux en Y). Quadruple immunosuppressive regimes included tacrolimus/cyclosporine, mycophenolate mofetil (MMF), steroid and antibodies induction which included antilymphocyte globulin (ALG) or anti CD25 monoclonal antibody.Result ED SPK without Roux en Y was successfully applied to all patients without serious complications such as pancreatitis, graft thrombosis and pancreatic fistula. The patients haveachieved immediate kidney allograft function and euglycemia with insulin independent. Episodes of acute rejection were observed in 4 cases, and 3 of them were reversed effectively. Early postoperative complications involved peritoneal infection (2/10), wound infection (2/10) and bleeding (1/10). Conclusion ED SPK without Roux en Y is preferable to the patients of IDDM with uremia.更多还原