糖尿病是临床常见病，据推测至2010年全球糖尿病患者预计将超过3.5亿，其中5%～10%的患者将因糖尿病晚期出现的糖尿病肾病、视网膜病变、微血管病变和神经末梢病变等并发症而直接影响生命，因此糖尿病及其并发症作为一项重要而艰巨的课题仍然困扰着广大医务工作者。胰腺移植和胰岛移植能增加患者胰岛素分泌细胞，从而有效地控制血糖，防止和改善糖尿病的并发症，提高生活质量，是治疗胰岛素依赖性糖尿病（IDDM）的有效手段。
ObjectiveTo evaluate the application of artery first approach in pancreaticodudenectomy, aiming to explore superior mesenteric artery(SMA) and celiac axis in early stage of operation, confirming the resectability and achieving radical resection of the nervous and lymphatic tissues around axis of celiac artery and SMA. MethodsThe data of 27 patients with suspected carcinoma in pancreatic head who received the artery first approach in pancreaticodudenectomy from Sep, 2009 to Dec, 2013 in our hospital were retrospectively analyized. ResultsEight cases received palliative drainage operation, while other 19 cases received radical pancreatectomy, including 2 cases total pancreatectomy and 17 cases pancreaticodudenectomy, with 5 cases portal vein or superior mesenteric vein resection and reconstruction, 1 case common hepatic artery resection, and 2 cases extended right pancreatectomy. The operative time was(281.28±78.53) min(133-354 min), and amount of bleeding was(352±537) mL(189-1 352 mL). There were no operative death, and no reoperation due to complications. ConclusionArtery first approach is preferred for patients with borderline resectable tumors, pancreatic surgeon should be familiar to the various approach.
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。