胰肾联合移植中的胰腺并发症(3)

http://www.100md.com 2003年9月26日 好医生

     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]。

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