背景技术用于治疗上腹部终末期疾病的腹部器官移植是外科医生的严重难题。病例报告我们进行了四重器官移植的临床评估(肝脏,胰腺,十二指肠,和肾脏)对于患有终末期肝病的患者,慢性乙型肝炎后肝硬化,尿毒症,和胰岛素依赖型糖尿病,并探索了最佳的手术方法。同时经典原位肝脏,胰腺-十二指肠,对一名46岁的男性进行了异位肾移植。该过程是通过单血管吻合术(肠系膜上动脉和腹腔动脉的Y移植物在the总动脉中一起开放)实施的手术的改进。胰腺分泌物和胆汁通过改良的未切割空肠环吻合术排出,捐献者的肾脏被放置在右髂窝。患者服用了巴利昔单抗,糖皮质激素,他克莫司,和霉酚酸酯用于免疫抑制。术后第3天(POD)肝功能恢复满意,术后第1个月(POM)胰腺功能恢复满意。移植肾发生肾积水,POD15的肌酐升高。因此,进行肾盂穿刺引流。他的肌酐在POD42时降至正常水平。无同种异体移植排斥或其他并发症,比如胰漏,血栓形成,或局部感染,发生了。病人肝脏正常,肾,POD365后,胰腺功能与胰岛素无关。结论同时经典原位肝,胰腺-十二指肠,对于胰岛素依赖型糖尿病合并终末期肝肾疾病患者,异位肾移植是一种有前途的治疗选择,本中心的经验可为临床多器官移植提供参考。
BACKGROUND Abdominal organ cluster transplantation for the treatment of upper abdominal end-stage diseases is a serious conundrum for surgeons. CASE REPORT We performed clinical assessment of quadruple organ transplantation (liver, pancreas, duodenum, and kidney) for a patient with end-stage liver disease, post-chronic hepatitis B cirrhosis, uremia, and insulin-dependent diabetes mellitus, and explored the optimal surgical procedure. Simultaneous classic orthotopic liver, pancreas-duodenum, and heterotopic renal transplantation was performed on a 46-year-old man. The process was an improvement of surgery implemented with a single vascular anastomosis (Y graft of the superior mesenteric artery and the celiac artery open together in the common iliac artery). The pancreatic secretions and bile were drained through a modified uncut jejunal loop anastomosis, and the donor\'s kidneys were placed in the right iliac fossa. The patient was prescribed basiliximab, glucocorticoid, tacrolimus, and mycophenolate mofetil for immunosuppression. The hepatic function recovered satisfactorily on postoperative day (POD) 3, and pancreatic function recovered satisfactorily in postoperative month (POM) 1. Hydronephrosis occurred in the transplanted kidney, with elevated creatinine on POD 15. Consequently, renal pelvic puncture and drainage were performed. His creatinine dropped to a normal level on POD 42. No allograft rejections or other complications, like pancreatic leakage, thrombosis, or localized infections, occurred. The patient had normal liver, renal, and pancreas functions with insulin-independent after POD 365. CONCLUSIONS Simultaneous classic orthotopic liver, pancreas-duodenum, and heterotopic renal transplantation is a promising therapeutic option for patients with insulin-dependent diabetes combined with end-stage hepatic and renal disease, and our center\'s experience can provide a reference for clinical multiorgan transplantation.