肝肾胰十二指肠联合切取及修整的技术改进  

Improved surgical technique of combined liver,kidney,pancreas and duodenum harvesting and back-table

作　　者：褚志强[1] 宋文利[1] 沈中阳[1] 

机构地区：[1]天津市第一中心医院移植外科,天津300192

出　　处：《中国临床解剖学杂志》2007年第2期221-223,共3页Chinese Journal of Clinical Anatomy

摘　　要：目的:探讨肝肾胰十二指肠联合切取及修整的技术改进。方法:采用原位灌注联合切取和体外修整的方法完成6例尸体供肝肾胰十二指肠联合切取及修整。结果:6例获取器官的热缺血时间为(3.0±1.5)min,冷缺血时间为(7.0±3.0)h。修整时动脉重建方式既保证了肝脏血供又改善了胰腺十二指肠血供。同时为6例乙肝肝硬化病人实施原位肝移植,术后病人恢复顺利;为6例I型糖尿病合并尿毒症病人实施胰液膀胱引流式胰十二指肠及肾一期联合移植术,手术顺利,术后病人移植胰腺和肾脏功能恢复良好;为6例慢性肾功能衰竭(尿毒症)病人实施肾移植术,术后病人恢复顺利。结论:肝肾胰十二指肠联合切取和修整的质量是器官移植成功的关键之一,采用原位灌注联合切取和保留胰腺的胃十二指肠动脉是可靠的。Objective： To summarize the improvement of the surgical technique for combined liver, kidney, pancreas and duodenum harvesting and back-table. Methods： The grafts from 6 cadaveric donors, including liver, pancreas, duodenum and bilateral kidneys were procured with methods of perfusion in situ, en bloc resection and prepared in ex vivo. Results： The warm ischemia time was （3.0±1.5） minutes, and the cold ischemia time （7.0±3.0） hours. The method of artery reconstruction ensured the blood flow of livers and pancreatoduodenums. By using the donor organs, liver transplantation was performed in six cases of hepatitis B hepatocirrhosis, simultaneous pancreatic kidney wanspaintation （SPKT） in six cases of insulin dependent diabetes mellitus with uremia, and kidney transplantation in six cases of uremia. The patients of liver transplantation and the patients of kidney transplantation recovered successfully. The functions of the pancreas and kidney grafts were restored without serious surgical complications in the six cases of SPKT. Conclusions： Consummate skill for procurement and back-table of liver, pancreas, duodenum and bilateral kidneys is one of the key points for grafts survival, and the total abdominal evisceration and artery reconstruct methods of retaining gastroduodenal artery are reliable .

关 键 词：肝脏 胰腺 肾 移植 器官切取 

分 类 号：R657.5[医药卫生—外科学]