糖尿病是臨床常見病，據推測至2010年全球糖尿病患者預計將超過3.5億，其中5%～10%的患者將因糖尿病晚期出現的糖尿病腎病、視網膜病變、微血管病變和神經末梢病變等并發癥而直接影響生命，因此糖尿病及其并發癥作為一項重要而艱巨的課題仍然困擾著廣大醫務工作者。胰腺移植和胰島移植能增加患者胰島素分泌細胞，從而有效地控制血糖，防止和改善糖尿病的并發癥，提高生活質量，是治療胰島素依賴性糖尿病（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.
目的總結胰腎聯合移植術后感染的特點，并對其預防及治療進行討論。方法對我院施行的2例胰腎聯合移植術后感染的臨床資料結合有關文獻進行討論。結果1例術后發生7次感染，其中2次為肺部感染，4次為泌尿系感染，1次為巨細胞病毒感染，移植之胰腎有功能存活3年余； 另1例發生呼吸系統及泌尿系統感染各1次，術后早期恢復尚可，3周發生急性腎排斥，7周死于混合菌感染敗血癥。結論胰腎聯合移植圍手術期感染根據其臨床特點，正確的圍手術期處理非常重要。