Surgical technique of combined kidney-pancreas transplantation
AbstractAim: to study influence of a surgical method of pancrea- ticoduodenal complex transplantation on current of the early postoperative period at patients with diabetes type I, complicated by diabetic nephropathy in ESRF (end stage renal failure).
Methods. 29 transplantations of pancreaticoduodenal complex to 26 patients are carried out from 2005 to 2011. Venous outflow was in portal system: portal vein anasto- mosis of a transplant «the end to side» of superior mesen- teric vein of recipient, pancreaticoduodenal complex was in an abdominal cavity, laterally of a colon ascendens. At 2012, 5 transplantations of pancreaticoduodenal com- plex are carried out to 5 patients with venous outflow in caval system: portal caval system anastomosis – Eck fis- tula, pancreaticoduodenal complex places in retroperito- neal space, on a place of remote right kidney.
Main results. It is difficult to compare number of post- operative complications because of small amount of pa- tients in group with caval outflow. In addition, there is an impression about smaller number of complications: if in group with portal outflow nearly a half of recipients were repeatedly operated, in group with caval outflow there was no repeated operations. By comparison of labo- ratory indicators during the first 10 days after operation it is revealed that at patients with caval outflow the aver- age level of pancreatic amylase of blood was authentically below, than at patients with portal outflow (145±208 vs 637±596 u/l, p=0,0002).
Conclusions. Use of portal outflow at transplantation of pancreaticoduodenal complex led to more favorable current of the early postoperative period at recipients of pancreaticoduodenal complex and a kidney.
Keywords:pancreas transplantation, portal outflow, caval outflow, reperfusion pancreatitis
Clin. Experiment. Surg. Petrovsky J. – 2013. – N 1. – Р. 54–57.