亲属活体部分小肠移植术后早期并发症的防治  

Prophylaxis and therapy of early complications for relatives partial live small bowel transplantation

作　　者：施海[1] 王为忠[1] 董光龙[1] 张洪伟[1] 管文贤[1] 

机构地区：[1]第四军医大学西京医院胃肠外科,西安710033

出　　处：《中华器官移植杂志》2006年第11期664-667,共4页Chinese Journal of Organ Transplantation

摘　　要：目的探讨亲属活体部分小肠移植术后早期并发症的防治。方法为3例短肠综合征患者和1例肠神经节缺失导致小肠无功能患者施行亲属活体部分小肠移植术,供、受者HLA配型均有4个以上抗原相合,供肠均取自回肠末端,长度为(150±10)cm,应用他克莫司、霉酚酸酯及甲泼尼龙预防排斥反应。术后采取抗凝、改善微循环、输注人白蛋白等措施调控患者的出、凝血功能,预防血管吻合口血栓形成和出血,给予法莫替丁或奥美拉唑预防应激性溃疡；给予头孢三代为主的抗生素、更昔洛韦以及氟康唑预防细菌、病毒及真菌感染,并注重对体表易感染部的消毒和护理；术后鼓励患者多下床活动,早期给予谷氨酰胺,尽早将营养支持治疗过渡为肠内营养,以促进移植肠功能的恢复。结果术后3d,1例患者发生肺部鲍曼不动杆菌感染,经抗生素治疗后控制。1例术后5 d移植肠系膜根部出现血肿,手术清除血肿。2例消化道分泌物及大便中发现真菌生长,给予氟康唑治疗后好转。4例在术后20 d左右均发生急性排斥反应,经加大FK506的用量,并以甲泼尼龙冲击治疗后逆转。4例患者,2例获得长期存活,至今分别存活6年8个月和3年2个月,另2例分别于术后5个月、35 d因感染死亡。结论小肠移植术后早期的并发症较多,与小肠的生理结构有关,术后早期并发症的成功防治是临床小肠移植成败的关键。Objective To investigate prophylaxis and therapy of early complications following relatives＇ partial live small bowel transplantation. Methods Four relatives＇ partial live small bowel transplantations were carried out. Among the 4 patients, there were 3 eases of short intestine syndrome and one case of non-function of small bowel caused by the absence of nerve ganglion of small intestine. More than 4 antigens of HLA were completely matched between donators and receptors. In testines of donators were got from terminal ileum with the length of （150± 10） cm. After operations, taerolimus （FK506）, mycophenolate mofetil （MMF）, and methylprednisolone were used to prevent rejections. Measures such as use of anticoagulation, improving microeirculation and albumin infusion, aimed at regulating the function of blood coagulation and preventing bleeding and formation of thrombus at anastomotie stoma; famotidine and omeprazole were used to prevent irritable ulcer; use of the third generation of cephalosporins antibiotics, ganeiclovir and fluconazol could prevent bacteria, vi rus and eumycete infections; disinfection and care of easily-infected organs were emphasized; receptors were encouraged to get out of their beds to move frequently; glutamine and enteral nutrition were used early to promote recovery of intestinal function. Results Three days after operation, one patient＇s lung was infected with baumanii, and the infection had been under control after being treated with the third generation cephalosporins antibiotics; five days after operation, haematoma was detected on an other patient and was cleared through the second operation; growth of eumycete was found in 2 patients＇ excretion and secretion from enteron, and their situations were improved with fluconazol; acute rejections of the 4 patients were detected 20 days after operation and reversed by the increased use of FKS06 combined with methylprednisolone. Among the 4 patients, 2 of them have survived for a long time, and the first patient has survi

关 键 词：小肠 移植 手术后并发症 活体供者 

分 类 号：R656.7[医药卫生—外科学]