小剂量奥曲肽预防肠内引流胰腺移植的应用。前瞻性随机单中心试验结果。

PubMed ID
发表日期 2005年Jun月

原始出处 临床移植
Clinical transplantation
作者 Hesse  Uwe J  Meester  Daan  Troisi  Roberto  Cathenis  Koen  Lameire  Norbert  Hemptinne  Bernard 

文献标题 小剂量奥曲肽预防肠内引流胰腺移植的应用。前瞻性随机单中心试验结果。
The use of low dose octreotide prophylaxis in pancreatic transplants with enteric drainage. Results of a prospective randomized single center trial.

文献摘要 AIM

本研究的目的是探讨奥曲肽对胰腺移植术后肠内瘘形成、胰腺炎、出血和血栓形成的影响,并在前瞻性随机单中心试验中与未接受奥曲肽的患者进行比较。

PATIENTS AND METHODS

40名胰腺移植受者前瞻性随机分为两组,一组在手术时皮下注射0.1毫克奥曲肽,另一组在术后7天内皮下注射3倍奥曲肽。术后第0-10天记录吻合口胰漏发生率和腹腔引流液中淀粉酶和脂肪酶的含量。两组在年龄、性别、糖尿病发病、手术方式和免疫抑制方案等方面具有可比性。

RESULTS

胰肾联合移植35例,胰腺单独移植5例,奥曲肽组2例,对照组3例,肾后2例,肝后1例,胰肾联合移植1例,单纯胰腺移植1例。所有患者均行肠内引流。20例接受奥曲肽治疗,20例未接受奥曲肽治疗。在一名接受奥曲肽治疗的患者中,由于吻合术引起的肠瘘(1/20=5%),胰腺因感染性并发症而不得不切除。奥曲肽组与非奥曲肽组的发病率分别为1比0(胰腺炎)、2比3(出血)、2比1(血栓形成)和2比0(胰腺瘘),两组患者的12个月生存率均为100%,胰腺生存率分别为85%和95%。原发性同侧胰肾移植成活率为93%。术后0~10天腹腔积液淀粉酶和脂肪酶浓度显示两组胰瘘形成情况相似。

CONCLUSION

胰腺移植术后应用奥曲肽不能阻止吻合口胰瘘的形成,也不能阻止胰囊引流胰腺移植术后胰瘘的形成。需要进一步的研究来最终评估这种预防性治疗的益处。


AIM

The aim of this study was to investigate the effect of octreotide in the perioperative course of pancreas transplants drained into the bowel in terms of fistula formation, pancreatitis, hemorrhage and thrombosis, and to compare the results to patients not receiving octreotide in a prospectively, randomized single center trial.

PATIENTS AND METHODS

Forty pancreas transplant recipients were prospectively randomized to either receive or not to receive octreotide 0.1 mg subcutaneously at the time of operation and 3x/d there after until post-operative day 7. The incidence of pancreatic leakage from the anastomosis and the content of peritoneal fluid drainage regarding amylase and lipase concentrations collected by abdominal drains were registered on day 0-10. Both groups were comparable for age, sex, onset of diabetes, surgical procedure and immunosuppressive regimen.

RESULTS

There were 35 simultaneous pancreas-kidney transplants and five solitary pancreas transplants, two in the octreotide and three in the control group two pancreas after kidney, one pancreas after liver pancreas, one pancreas after simultaneous pancreas kidney transplantation, one pancreas transplant alone. All had enteric drainage. Twenty patients received octreotide and 20 did not. In one patient, receiving octreotide the pancreas had to be removed for septic complications because of an enteric fistula arising from the anastomosis (1/20 = 5%). The incidence in patients on octreotide vs. non-octreotide was 1 vs. 0 for pancreatitis, 2 vs. 3 for hemorrhage, 2 vs. 1 for thrombosis and 2 vs. 0 for pancreatic fistulae resulting in an actual overall 12 months patient survival of 100% in both groups and a pancreas survival of 85% vs. 95%. For primary simulaneous pancreas kidney the pancreas graft survival was 93%. The amylase and lipase concentrations of fluid collections drained into the peritoneum on day 0 to 10 post-operatively indicating pancreatic fistulization was comparable in both groups.

CONCLUSION

The use of octreotide following pancreas transplantation did not prevent pancreatic fistula formation from the anastomosis neither from the pancreatic capsule in pancreas transplantation with enteric drainage. Further studies are required to finally evaluate the benefit of this prophylactic treatment.


获取全文 10.1111/j.1399-0012.2005.00208.x