亲体小肠移植血管重建与二期肠吻合手术方式探讨  

Graft vascular anastomosis and two-stage reconstruction of the intestine in living-related small bowel transplantation

作　　者：钱世鹍[1] 何晓顺[2] 朱晓峰[2] 

机构地区：[1]广州医学院第二附属医院器官移植中心,510260 [2]中山大学附属第一医院器官移植中心

出　　处：《中华普通外科杂志》2007年第6期427-430,共4页Chinese Journal of General Surgery

基　　金：中国博士后科学基金资助项目（2004036519）

摘　　要：目的 探讨亲体小肠移植的手术技术和方式。方法 对1例短肠综合征患者分两期实施亲体小肠移植手术，一期手术采用患者母亲120cm回肠作为供体，动脉与受体乙状结肠动脉吻合、静脉与肠系膜下静脉属支吻合、移植肠襻两端腹壁造口；二期手术于首次术后188d将受体残留小肠横断，分别与移植肠襻的近、远端作端一侧吻合，保留原腹壁造瘘口。结果 两期手术顺利，先后发生的急性排斥反应和巨细胞病毒感染均得到有效控制，未发生消化道漏。受体已生存213d，二期手术后25d，体重增加4．5kg，进半流质饮食，生活能自理。结论 术前完善的检查和处理，术前设计多套方案对手术中的应变非常重要；采用门静脉回流方式是较为理想的术式；对移植肠襻采用二期吻合的方式降低了肠瘘的发生率。Objective To investigate the surgical techniques and modalities in a recipient of living-related small bowel transplantation （LR-SBTx）. Methods A patient with short gut syndrome has undergone living-related small bowel transplantation successfully in two stages. On the first stage, 120 cm of ileum from his mother was transplanted into the recipient. The graft blood vessels were anastomosed by end-to-side, with the graft artery anastomosed to recipient sigmoid arteries and the graft vein to the recipient inferior mesenteric vein respectively. Both ends of the transplanted intestine were made stomas on the abdominal wall. The second stage begins after 188 days of the first operation. The residual small bowel was transected with both ends being anastomosed to the proximal and distal end of the graft respectively. The stomas were left intact. Results This two stage procedure was successful. Acute graft rejection and infection of CMV that consecutively developed during the postoperative course was put under successful control. There was no leakage on the intestinal anastomosis. It is now 25 days after the second operation, the patient gained 4. 5 kg in body weight. He takes semifluid food and cares himself independently now. Conclusions A detailed examination and management before operation, and several prepared surgical schemes adapting to changes during operation are important steps to insure the safety of the recipient. The portal vein drainage of the graft venous system is an ideal style for LR-SBTx. The reconstruction of the intestine in two stages in LR-SBTx decreases the incidence of intestinal fistula.

关 键 词：短肠综合征 移植 吻合术 外科 

分 类 号：R686[医药卫生—骨科学]