胰肾联合移植中的胰腺并发症(3)
脱水的病人中92%合并代谢性酸中毒。脱水比代谢性酸中毒更为复杂，术后第一年内有43%的患者因脱水而需住院治疗，脱水是胰-肾联合移植后最常见的住院原因。脱水常使肌酐升高超过正常值的1/4，不易与排斥反应和环孢素肾毒性鉴别，脱水同样随着时间的延长，而逐渐变轻[25]。
3.2 胰静脉血直接流入体循环引起的并发症
目前胰腺移植盛行的方法是移植胰的门静脉与受者的髂静脉做端侧吻合，提供胰的静脉回流[27]。胰静脉血未经肝脏代谢直接进入体循环，导致受者发生持续高胰岛素血症，受者的代谢特征表现为血糖正常、高胰岛素血症及胰岛素耐受[28]。随访显示高胰岛素血症加速了人类的动脉粥样硬化过程[28]。另外Diem等[29]的研究显示胰静脉血直接流入体循环，提高了刺激产生胰岛素的水平。上述并发症的预防是供胰的门静脉与受者的肠系膜上静脉做端侧吻合，使供胰的静脉血先经过肝脏，再进入体循环，这样可避免高胰岛素血症所带来的并发症[28]。
, 百拇医药
参考文献
1. Hathaway ,D.K.,Hartwig, M.S,Mislstead,J. et al.Ttansplant.Proc,1994,26:512
2. Sutherland,DER. International Pancreas Transplant Registry. Presented at the 5th congress of the international Pancreas and islet Transplant Association, Miami Beach, Florida, 1995 June 18-22.
3. Sutherland,DER.Cecka,M.and Grussner,AC. Transplant Prlc.1999,31:597-601
4. Sutherland D.E.R.and Gruessner. Transplant Proc,1995,27:2977
, http://www.100md.com
5. Troppmann,C.Benedtti,E.Papalois, B.E. et al. Transplant proc,1995.27:1331
6. Dubernatd,J.M.Martin,X.Leftancois, N. et al. Transplant Proc, 1992,24:769
7. Corry, R J. Egidi,M F. Shapiro, R. et al。Transplant Proc,1995.27:3048
8. Elkhammas,E A. Henry, M L. Tesi, R J. et al. Transplant Proc,1994.26:453
9. Humar,A.Harmon,J,Grussner,A. et al. T-Proc,1999:606
, http://www.100md.com
10.Saudek,F.Adamec,M.Ekberg,H. Et al. First experience with combined pancreatic-renal transplantation with extraperitoneal placement of the whole pancteatic graft transplant proc,1995.27:3080
11. Schweitzer E. J. Bartlett S T. Transplant Proc,1994.26:461
12. Sindhi,R.Stratta,R. J. Taylor, R. J. et al. Transplant Proc,1995, 27:3014
13. Sakopoulos, A M G. Leapman, S B. et al. Transplant Proc, 1995. 27:3008
, 百拇医药
14. Nakhleh,R E. Benedetti, E. Gruessner,A.et al. Transplantation,1995.60:541
15. Esterl,R M.Stratta,R J. et al. Transplant 1995.9:155
16. Kuhr, C.S. Davis, C. L. Barr, D. et al. J.urol, 1995.153:316
17.Sansalone,CV.Aseni,P.Follini,ML. et al. Transplant Proc,1998,30:251-252
18.Sollinger,H. W.Messing, E.M.Eckhorr,DE. et al. Ann.Surg.1993,218:561
, http://www.100md.com
19.Vanderpiji, J.Smers,Y.F. et al.Fudnte, R. et al. Transplant Proc,1995.27:3105
20.Smith,J. L, see, W. A. Ames, S. A.et al. Transplant Proc,1991.23:1611
21.Fernadez – Cruz, L. Sabater, L.Gilabert R. et al. Brit.J.Urol.1993.80:1429
22.Ciamcio,G. Burke, G.Lynne, C. et al. Transplant Proc,1997.29:2912-2913
23.Rana,A.Hand,M.F.Chisholm,G.D. et al. J.Urol.1994.151:973
, 百拇医药
24.Keplan, A J. Rames, R. and Bromberg, J S. Transplantation,1995.59:910
25.Ketel,B.Henry,M.L.Elkhammas, E.A. et al. Transplant Proc,1992.24:774
26.Sugitani, A. Gritsch,HA. Shapiro, R. et al. Transplant Proc,1998,30:293
27.Sollinger H W. Cook K, Kanps D. et al. Transplant Proc,1984 16:749
28.Gaber,A O.Shokouh – Amiri H. Hathaway, D K. et al. Transplant Proc,1993.25:1176
29.Diem P. Abid M. Redmom J B. et al. Diaberes, 1990 19:534, 百拇医药(马潞林 管德林)
3.2 胰静脉血直接流入体循环引起的并发症
目前胰腺移植盛行的方法是移植胰的门静脉与受者的髂静脉做端侧吻合，提供胰的静脉回流[27]。胰静脉血未经肝脏代谢直接进入体循环，导致受者发生持续高胰岛素血症，受者的代谢特征表现为血糖正常、高胰岛素血症及胰岛素耐受[28]。随访显示高胰岛素血症加速了人类的动脉粥样硬化过程[28]。另外Diem等[29]的研究显示胰静脉血直接流入体循环，提高了刺激产生胰岛素的水平。上述并发症的预防是供胰的门静脉与受者的肠系膜上静脉做端侧吻合，使供胰的静脉血先经过肝脏，再进入体循环，这样可避免高胰岛素血症所带来的并发症[28]。
, 百拇医药
参考文献
1. Hathaway ,D.K.,Hartwig, M.S,Mislstead,J. et al.Ttansplant.Proc,1994,26:512
2. Sutherland,DER. International Pancreas Transplant Registry. Presented at the 5th congress of the international Pancreas and islet Transplant Association, Miami Beach, Florida, 1995 June 18-22.
3. Sutherland,DER.Cecka,M.and Grussner,AC. Transplant Prlc.1999,31:597-601
4. Sutherland D.E.R.and Gruessner. Transplant Proc,1995,27:2977
, http://www.100md.com
5. Troppmann,C.Benedtti,E.Papalois, B.E. et al. Transplant proc,1995.27:1331
6. Dubernatd,J.M.Martin,X.Leftancois, N. et al. Transplant Proc, 1992,24:769
7. Corry, R J. Egidi,M F. Shapiro, R. et al。Transplant Proc,1995.27:3048
8. Elkhammas,E A. Henry, M L. Tesi, R J. et al. Transplant Proc,1994.26:453
9. Humar,A.Harmon,J,Grussner,A. et al. T-Proc,1999:606
, http://www.100md.com
10.Saudek,F.Adamec,M.Ekberg,H. Et al. First experience with combined pancreatic-renal transplantation with extraperitoneal placement of the whole pancteatic graft transplant proc,1995.27:3080
11. Schweitzer E. J. Bartlett S T. Transplant Proc,1994.26:461
12. Sindhi,R.Stratta,R. J. Taylor, R. J. et al. Transplant Proc,1995, 27:3014
13. Sakopoulos, A M G. Leapman, S B. et al. Transplant Proc, 1995. 27:3008
, 百拇医药
14. Nakhleh,R E. Benedetti, E. Gruessner,A.et al. Transplantation,1995.60:541
15. Esterl,R M.Stratta,R J. et al. Transplant 1995.9:155
16. Kuhr, C.S. Davis, C. L. Barr, D. et al. J.urol, 1995.153:316
17.Sansalone,CV.Aseni,P.Follini,ML. et al. Transplant Proc,1998,30:251-252
18.Sollinger,H. W.Messing, E.M.Eckhorr,DE. et al. Ann.Surg.1993,218:561
, http://www.100md.com
19.Vanderpiji, J.Smers,Y.F. et al.Fudnte, R. et al. Transplant Proc,1995.27:3105
20.Smith,J. L, see, W. A. Ames, S. A.et al. Transplant Proc,1991.23:1611
21.Fernadez – Cruz, L. Sabater, L.Gilabert R. et al. Brit.J.Urol.1993.80:1429
22.Ciamcio,G. Burke, G.Lynne, C. et al. Transplant Proc,1997.29:2912-2913
23.Rana,A.Hand,M.F.Chisholm,G.D. et al. J.Urol.1994.151:973
, 百拇医药
24.Keplan, A J. Rames, R. and Bromberg, J S. Transplantation,1995.59:910
25.Ketel,B.Henry,M.L.Elkhammas, E.A. et al. Transplant Proc,1992.24:774
26.Sugitani, A. Gritsch,HA. Shapiro, R. et al. Transplant Proc,1998,30:293
27.Sollinger H W. Cook K, Kanps D. et al. Transplant Proc,1984 16:749
28.Gaber,A O.Shokouh – Amiri H. Hathaway, D K. et al. Transplant Proc,1993.25:1176
29.Diem P. Abid M. Redmom J B. et al. Diaberes, 1990 19:534, 百拇医药(马潞林 管德林)