【摘要】目的探讨肝肠联合移植的术式、免疫抑制治疗方案与效果。方法对一中年男性短肠综合征患者施行辅助性肝肠联合移植，术后患者免疫抑制治疗采用甲波尼龙（MP）、环孢素A（CsA）、环磷酰胺（CTX）与抗淋巴细胞球蛋白（ALG）处理。结果术后观察期内移植物存活良好。结论本例采用的免疫抑制治疗方案是成功的，且手术方法操作较为简便、易行。
近40年来，胰腺移植在基础和临床研究方面都获得了令人振奋的长足进步。据国际胰腺移植登记中心（IPTR）记录，全球已实施了18 900余例胰腺移植（截至2002年10月），其中绝大多数在美国（近14 000例），约90%为胰肾联合移植（SPK）。迄今为止，SPK被公认是治疗糖尿病合并肾功能衰竭的最有效的方法。据报道，胰腺移植受体1年生存率超过95%，3年生存率接近90%； 移植胰腺有功能（患者不依赖胰岛素）者的1年和3年生存率分别为83%和77%。
ObjectiveTo do a brief introduction and prospects for simultaneous pancreas and kidney transplanta-tion from aspects of recipient screening, choice of operative method, prognosis, quality of life, and complications. MethodDomestic and international literatures were collected to summary the effect, prognosis, and the latest progress of simultaneous pancreas and kidney transplantation in the treatment of diabetes. ResultsAs a kind of mature treatment of diabetic with end-stage renal disease, simultaneous pancreas and kidney transplantation had been carried out in most transplantation centers around the world, it had the definite therapeutic effect and controllable side effects, the life quality of posttransplantation patients would be improved notably. However, the screen of transplantation patient, the selection of transplantation operation, and the postoperative immunosuppressive protocols had not yet been reached a consensus. ConclusionsSimultaneous pancreas and kidney transplantation is the most effective treatment for type 1 diabetes patients with end-stage renal disease, it provides a more feasible and more physiological way for the secretion of insulin. Although the patient has to undergo a major operation and take some risk, simultaneous pancreas and kidney transplantation still improves the patient's survival rate and the quality of life, and reduces the incidence of complications related to diabetes. Based on the above reasons, simultaneous pancreas and kidney transplantation should be a preferred treatment for all eligible patients.
ObjectiveTo investigate the effectiveness of combined tissue transplantation for repair of serially damaged injuries on radial side of hand and function reconstruction. MethodsBetween May 2013 and May 2017, 34 cases of serially damaged injuries on radial side of hand were treated. There were 29 males and 5 females; aged 17-54 years, with an average of 32.1 years. There were 23 cases of crushing injuries, 5 cases of bruising injuries, 4 cases of machine strangulation injuries, and 2 cases of explosion injuries. The time from injury to admission was 40 minutes to 3 days, with an average of 10 hours. According to the self-determined serially damaged injuries classification standard, there were 1 case of typeⅠa, 2 cases of typeⅠb, 10 cases of typeⅡa, 5 cases of type Ⅱb, 3 cases of type Ⅱc, 1 case of type Ⅱd, 7 cases of type Ⅲa, 3 cases of type Ⅲb, 1 case of type Ⅲc, and 1 case of type Ⅲd. According to the classification results, the discarded finger, nail flap, the second toe, anterolateral thigh flap, ilium flap, fibula flap, and other tissue flaps were selected to repair hand wounds and reconstruct thumb, metacarpal bones, and fingers. ResultsAfter operation, 2 cases of flaps developed vascular crisis and survived after symptomatic treatment; the other transplanted tissue survived smoothly. All cases were followed up 1 to 7 years, with an average of 2.4 years. The average fracture healing time was 7.4 weeks (range, 5.3-9.0 weeks). At last follow-up, the reconstructed fingers and the grafted flaps recovered good sensory function, with a two-point discrimination of 5 to 11 mm (mean, 9 mm). According to the evaluation standard of the upper limb function evaluation of the Chinese Medical Association Hand Surgery Society, the reconstructed thumb was rated as excellent in 24 thumbs, good in 8 thumbs, and fair in 2 thumbs; the reconstructed finger was rated as excellent in 18 fingers, good in 2 fingers, and fair in 1 finger. ConclusionFor the serially damaged injuries on radial side of hand, according to its classification, different tissues are selected for combined transplantation repair and functional reconstruction, which can restore hand function to the greatest extent and improve the quality of life of patients.
ObjectiveTo summarize the perioperative management experience and the treatment strategy of hyperkalemia after simultaneous pancreas and kidney transplantation (SPK).MethodThe clinical data of patients with diabetes combined with end-stage renal disease who accepted SPK in the Organ Transplantation Center of West China Hospital of Sichuan University from November 2017 to November 2019 were retrospectively analyzed.ResultsA total of 6 patients accepted SPK totally. The cold ischemia time of all allografts was less than 8 h. The levels of fasting blood glucose and serum creatinine were normal in the 5 surviving patients, and the diabetic complications were relieved or improved, except for 1 patient who died of cardiac arrest due to acute left heart failure. There were 1 case of delayed primary renal function recovery, 2 cases of bleeding in the surgical area of pancreas transplantation, 1 case of gastrointestinal bleeding, 3 cases of microthrombosis in the blood vessels of pancreas transplantation, 2 cases of perirenal effusion infection, 2 cases of pulmonary infection, and 1 case of ureterobladder anastomotic leakage, all of which were cured after symptomatic treatment. Only 2 patients occurred hyperkalemia after SPK (the highest level was 6.49 mmol/L and 6.67 mmol/L respectively), and transfusion of 10% glucose injection contain insulin, emergency dialysis and oral fludrocortisone were successively performed on them to restore the potassium density in 1 month and 2 months after surgery. There were no complications of perioperative surgical technical hemorrhage, intestinal leakage, large arteriovenous thrombosis, necrotizing pancreatitis, etc.ConclusionsSPK is the most effective treatment for patients with diabetes combined with end-stage renal disease. Transfusion of 10% glucose injection contain insulin, emergency dialysis, and oral fludrocortisone are effective strategies in treating hyperkalemia after SPK.
【Abstract】Objective To investigate the potential role of tumor necrosis factoralpha (TNFα) in apoptosis after combined liver and kidney transplantation in rats. MethodsEighty rats which had combined liver and kidney transplantation were randomly paired, were divided into study group (n=20) and control group (n=20). 40 ml of 4 ℃ sodium chloride and antiTNFα monoclonal antibody (30 ml was infused from portal veins to donated livers and 10 ml from renal arteries to donated kidneys) were infused to the study group (0.1 mg/kg weight),and the same quantity of 4 ℃ sodium chloride was infused the control group. Venous blood was drew at different phases after the transplantations to detect the function of kidney and liver. The level of TNFα and the cell apoptosis were detected in the transplanted tissues of liver and kidney by ELISA and terminal deoxynucleotidy transferase mediated dTUPbiotin nickend labeling (TUNEL). ResultsThe levels of AST, ACT, Cr and BUN in the study group were significantly lower than those of the control group at the same phases (P＜0.05). The level of TNFα in the transplanted tissues of kidney and liver was also significantly lower as compared with those of control group. The cell apoptosis index of the transplanted tissues of kidney and liver was significantly smaller in the study group （P＜0.05）. There was no dramatically pathological change in the tissues of transplanted kidney and liver, which were treated with antiTNFα monoclonal antibody, and the structures are almost normal. ConclusionAntiTNFα monoclonal antibody may reduce cell apoptosis and accelerate the restoration of function of liver and kidney after combined liver and kidney transplantation.
Abstract： Objective To investigate the protective effects of adenosine (ADO) on lung ischemia/reperfusion injury following heart-lung transplantation in canine. Methods Canine heart-lung transplantation was performed．Canines were divided into two groups: transplant control groupand ADO group. The changes of arterial partial pressure of oxygen(PaO2) after reperfusion in two groups at 30，60，90，120 min were observed．The tissue contents of nitric oxide (NO) were measured at 10 min before ischemia, 10 min and 120 min after ischemia; 10 min and 60 min after reperfusion．The lung tissue samples were obtained 1h after reperfusion．The tissue myeloperoxidase(MPO) activity,content of malondialdehyde(MDA), content of superoxide dismutase(SOD), wet/dry ratio of lung(W/D) were measured.Microscopic examination of lungs was also conducted. Results (1)In ADO group，PaO2 were significantly higher than that in control group at 30，60，90 and 120 min after reperfusion (Plt;0.05)．(2) The tissue contents of NO at 120 min after ischemia, 10 min and 60 min after reperfusion were significantly lower than that at 10 min before ischemia(Plt;0.05). In ADO group，the tissue contents of NO at 120 min after ischemia, 10 min and 60 min after reperfusion were higher than that in control group respectively(Plt;0.05). (3)The tissue MPO activity, content of MDA, W/D in ADO group were significantly lower than those in corresponding control group. The content of SOD in ADO group were higher than that in control group(Plt;0. 05)．(4)The microscopic examination showed that there were severe leukocyte infiltration and edema formation in the alveolar space in control group, but the changes were less severe in ADO group. Conclusion Administration of ADO in canine heart-lung transplantation can protect the donor lung against ischemia／reperfusion injury．
ObjectiveTo understand the research progress of treatment of hyperkalemia after simultaneous pancreas and kidney transplantation (SPK), and to provide the basis for the prevention and treatment of hyperkalemia after SPK.MethodThe relevant literatures about hyperkalemia after SPK in recent years were reviewed.ResultsThe pancreas and kidney that maintained the stability of serum potassium in different ways had been confirmed in current studies. The newly transplanted organ dysfunction after SPK and the use of drugs after SPK both caused hyperkalemia. The treatment principle of hyperkalemia after SPK was to take corresponding prevention and treatment measures according to different reasons.ConclusionsSPK is the best treatment for diabetic renal failure. Postoperative hyperkalemia is one of the most common complications, and timely and correct management is of great significance to the survival and prognosis of patients.
目的探讨肝肾联合移植的手术技术及临床治疗经验。方法对1例原发性弥漫性肝癌、肝硬变合并肾病综合征、慢性肾功能衰竭患者施行一期肝肾联合移植术，肝移植采用改良背驮式肝移植技术，肾移植采用常规方法。术前、术后行全身辅助性化疗。结果移植肝肾发挥功能，无手术并发症发生，术后3个月无肿瘤复发征象及远处转移，AFP下降到25 μg/L以下。结论对常规手术无法切除且无远处转移的肝癌合并肾功能衰竭者行肝肾联合移植，可以取得较好的临床治疗效果。
目的总结胰肾联合移植术后感染的特点，并对其预防及治疗进行讨论。方法对我院施行的2例胰肾联合移植术后感染的临床资料结合有关文献进行讨论。结果1例术后发生7次感染，其中2次为肺部感染，4次为泌尿系感染，1次为巨细胞病毒感染，移植之胰肾有功能存活3年余； 另1例发生呼吸系统及泌尿系统感染各1次，术后早期恢复尚可，3周发生急性肾排斥，7周死于混合菌感染败血症。结论胰肾联合移植围手术期感染根据其临床特点，正确的围手术期处理非常重要。