上腹部器官簇移植供体器官的切取及修整  

Procurement and trimming of epigastric multivisceral cluster graft

作　　者：马毅[1] 朱晓峰[1] 何晓顺[1] 王国栋[1] 王东平[1] 胡红星[1] 钱世鹍[1] 鞠卫强[1] 巫林伟[1] 詹文华[1] 

机构地区：[1]中山大学附属第一医院器官移植中心,广州510080

出　　处：《中华普通外科杂志》2006年第6期390-392,395,共4页Chinese Journal of General Surgery

基　　金：卫生部临床学科重点项目(97040230);广东省自然科学基金(05300768)资助项目

摘　　要：目的探讨上腹部多器官移植中器官簇的切取、修整、血管整形方法及移植效果。方法5例供体器官簇的获取均采用腹部多器官联合切取,腹主动脉、肠系膜上静脉、胆道及十二指肠同时灌注降温。供体器官簇的肠系膜上动脉和腹腔干分别与取自供体的髂内、外动脉预先行端端吻合,再通过髂总动脉与受体腹主动脉单口端侧吻合(动脉“搭桥”)。受体行上腹部肝、胆、胰、脾、十二指肠、全胃、空肠上段及大小网膜切除,接受肝、胰、十二指肠器官簇移植。结果5例患者移植术后器官簇存活及功能均良好,肝胰功能均在术后1周左右恢复正常。其中2例患者分别于术后第2天、第3天出现十二指肠空肠吻合口瘘,经再次手术后治愈。目前,除1例患者于术后3个月肿瘤复发、肺转移,死于全身衰竭外；其余4例患者移植物功能良好,现均已存活达6个月。结论获取质量良好的上腹部器官簇及适当的血管整形,是保证移植效果的前提；上腹部器官簇移植是治疗上腹多脏器恶性肿瘤的有效治疗方法。Objective To explore the procurement, trimming and arterioplasty of epigastric multivisceral cluster graft and effects of cluster transplantation. Methods The multivisceral cluster grafts （ liver, pancreas and duodenum） were procured after perfusing with cool UW solution simultaneously donor＇s abdominal aorta, superior mesenteric vein, biliary tree and duodenum in 5 cases. The donor＇s superior mesenteric artery and celiac artery were anastomosed to internal and external iliac artery respectively, and common iliac artery was anastomosed to reeipient＇s aorta. The recipient＇s epigastric organs including liver, pancreas, spleen, duodenum, stomach, proximal jejunum and omentum were removed. The organ cluster graft including liver, pancreas and duodenum was transplanted into 5 recipients suffering from epigastric multivisceral malignance. Results All 5 patients recovered with transplanted cluster organs functioning satisfactorylly. Duodenum-jejunum anastomotic fistula occurred on the second and third day in 2 cases respectively, which needed second operation. Postoperatively one case died of overwhelming tumor recurrence 3 months later. The other 4 cases have been doing well after more than 6 months follow-up without evidence of tumor recurrence. Conclusions High quality procurement of organ cluser graft and suitable arterioplasty are precondition of successful transplantation ; The transplantation of organ cluster is an effective therapy for epigastric cancer with local metastasis.

关 键 词：器官移植 肿瘤各部位 供体切取 

分 类 号：R656[医药卫生—外科学]