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胰肾联合移植临床技术规范(2020版)

中华医学会器官移植学分会

中华医学会器官移植学分会. 胰肾联合移植临床技术规范(2020版)[J]. 器官移植, 2020, 11(3): 332-343. doi: 10.3969/j.issn.1674-7445.2020.03.003
引用本文: 中华医学会器官移植学分会. 胰肾联合移植临床技术规范(2020版)[J]. 器官移植, 2020, 11(3): 332-343. doi: 10.3969/j.issn.1674-7445.2020.03.003
Branch of Organ Transplantation of Chinese Medical Association. Clinical technical specification for combined pancreas-kidney transplantation(2020 edition)[J]. ORGAN TRANSPLANTATION, 2020, 11(3): 332-343. doi: 10.3969/j.issn.1674-7445.2020.03.003
Citation: Branch of Organ Transplantation of Chinese Medical Association. Clinical technical specification for combined pancreas-kidney transplantation(2020 edition)[J]. ORGAN TRANSPLANTATION, 2020, 11(3): 332-343. doi: 10.3969/j.issn.1674-7445.2020.03.003

胰肾联合移植临床技术规范(2020版)

doi: 10.3969/j.issn.1674-7445.2020.03.003
基金项目: 

国家自然科学基金 81570680

国家自然科学基金 81571555

国家自然科学基金 81970654

详细信息
    作者简介:

    中华医学会器官移植学分会:石炳毅,男,1951年生,教授,主任医师,研究方向为器官移植临床与基础免疫学,Email:shibingyi666@126.com; 付迎欣,1978年生,博士,主任医师,研究方向为肾移植及胰腺移植,Email:shibingyi666@126.com

    通讯作者:

    石炳毅,男,1951年生,教授,主任医师,研究方向为器官移植临床与基础免疫学,Email:shibingyi666@126.com; 付迎欣,1978年生,博士,主任医师,研究方向为肾移植及胰腺移植,Email:shibingyi666@126.com

  • 中图分类号: R617, R587.1

Clinical technical specification for combined pancreas-kidney transplantation(2020 edition)

More Information
  • 摘要: 为了进一步规范胰肾联合移植临床技术,中华医学会器官移植学分会组织器官移植学专家从糖尿病肾病分型诊断,胰肾联合移植适应证和禁忌证、手术及外科并发症、免疫抑制方案、排斥反应、病理、术后复发性糖尿病、受者随访等方面,制订本规范。

     

  • 图  1  胰肾联合移植手术方式示意图

    A图示体静脉回流肠道引流术式;B图示体静脉回流膀胱引流术式;C图示同侧胰肾体静脉回流肠道引流术式

    Figure  1.  Schematic diagram of the operation of combined pancreas-kidney transplantation

    表  1  糖尿病肾病的临床分期

    Table  1.   Clinical stage of diabetic kidney disease

    GFR白蛋白尿分期
    分期数值mL/(min·1.73m2)A1期ACR < 30 mg/gA2期ACR30~300 mg/gA3期ACR > 300 mg/g
    G1正常≥90低危中危高危
    G2轻度降低60~89低危中危高危
    G3a轻到中度降低45~59中危高危极高危
    G3b中到重度降低30~44高危极高危极高危
    G4重度降低15~29极高危极高危极高危
    G5肾衰竭15极高危极高危极高危
    注:① ACR为尿白蛋白与肌酐比值。
    下载: 导出CSV

    表  2  DKD肾小球病理学分级标准

    Table  2.   DKD glomerular pathological grading criteria

    分级描述标准
    I单纯肾小球基底膜增厚光学显微镜下显示无或轻度特异性改变;电子显微镜提示肾小球基底膜增厚;女性 > 395 nm, 男性 > 430 nm(年龄≥9岁);病理改变未达到Ⅱ、Ⅲ或Ⅳ级
    Ⅱ a轻度系膜基质增宽超过25%的肾小球有轻度系膜基质增宽,病理改变未达到Ⅲ、Ⅳ级
    Ⅱ b重度系膜基质增宽超过25%的肾小球有轻度系膜基质增宽,病理改变未达到Ⅲ、Ⅳ级
    结节性硬化1个以上结节性硬化;病理改变未达Ⅳ级
    晚期糖尿病肾小球硬化总肾小球硬化率>50%,同时存在Ⅰ ~ Ⅲ级病理改变
    下载: 导出CSV

    表  3  胰肾联合移植随访频次

    Table  3.   Follow-up frequency of combined pancreas-kidney transplantation

    指标术后1~3个月术后4~6个月术后7~12个月术后1年以后
    血常规1次/周1次/2周1次/2~3周1次/月
    生化1次/周1次/2周1次/2~3周1次/月
    尿常规1次/周1次/2周1次/2~3周1次/月
    血药浓度1次/周1次/2周1次/2~3周1次/月
    C肽、糖化血红蛋白1次/月1次/3个月1次/半年
    PRA视情况定1次/年
    肾脏、胰腺超声1次/月1次/3个月1次/半年
    胸部CT或X线胸片视情况定1次/年
    骨扫描视情况定1次/年
    心电图、超声心动图视情况定1次/年
    下载: 导出CSV
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出版历程
  • 收稿日期:  2020-03-03
  • 网络出版日期:  2021-01-19
  • 刊出日期:  2020-05-15

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