目的

总结7例胰肾一期联合移植治疗糖尿病肾病合并尿毒症的疗效。

方法

2005年1月至2008年9月我中心完成7例胰肾联合一期移植，采用空肠引流方式。免疫抑制治疗方案术后早期采用四联诱导方案：他克莫司（FK506）+霉酚酸酯（MMF）+甲基强的松龙（MP）＋抗CD25单抗（赛尼哌或舒莱），后改为逐渐过渡至单用FK506维持治疗。

结果

回顾分析以上7例患者围手术期及长期随访情况：7例手术均获得成功，移植肾功能术后即刻恢复，6例患者术后第10天血糖降至正常水平，并完全停用外源性胰岛素。共发生急性排斥4例，除1例患者在连续肾脏替代疗法（CRRT）过程中并发心脑血管意外后家属放弃治疗外，其余3例患者经抗胸腺细胞球蛋白（ATG）+MP冲击治疗后移植肾功能均逆转恢复。早期的并发症包括伤口感染和出血。

结论

胰肾联合移植是治疗糖尿病合并终末期糖尿病肾病的有效方法。

Objective

To summarize the results of simultaneous pancreas-kidney transplantation(SPK)in the treatment of DM with uremia.

Methods

Seven cases of DM with uremia were received SPK from January 2005 to September 2008.The pancreatic allograft exocrine secretion was drained into the proximal jejunum via a side-to-side duodenojujunostomy. Quadruple immunosuppressive regimes including tacrolimus/cyclosporine,mycophenolate mofetil(MMF),methylprednisolone and anti-CD25 monoclonal antibody were used.

Results

SPK was successfully applied to all patients without serious complications such as pancreatitis, graft and pancreatic fistula. Seven of the patients had achieved immediate kidney allograft function and six of them achieved euglycemia with insulin independent ten days after the operation. Acute rejection were observed in four cases，one case died of cardio-cerebral vascular accident and another three cases were reversed effectively by the treatment of ATG+MP.Early postoperative complications involved wound infection and bleeding.

Conclusion

SPK is efficacious treatmentto the patients of DMwith uremia.