腹部多器官联合移植供器官切取方法探讨  

The optimized technique of abdominal multiple organ procurement and transplantation

作　　者：于立新[1] 叶俊生[1] 徐健[1] 付绍杰[1] 杜传福[1] 邓文锋[1] 王亦斌[1] 余玉明[1] 魏强[1] 李川江[1] 

机构地区：[1]南方医科大学附属南方医院器官移植科,广州510515

出　　处：《中国临床解剖学杂志》2008年第5期566-568,共3页Chinese Journal of Clinical Anatomy

摘　　要：目的:总结腹部多器官联合移植供器官的切取方法,观察其临床应用效果。方法:1999～2006年共行肝肾联合移植18例,肝胰联合移植1例,胰肾联合移植6例,均采用腹部多器官联合切取技术,优先灌注腹主动脉,于小肠系膜根部分离肠系膜上静脉,插管灌注肝门静脉,整块切取肝、脾、肾、以及胰腺和部分十二指肠。结果:腹腔多器官联合切取时间为(16.0±3.0)min,热缺血时间(3±1.2)min,所有供器官、血管无损伤,灌注良好。术后移植物功能恢复顺利,无移植肝原发无功能发生,无严重胆道并发症发生。肝肾联合移植患者术后ALT恢复正常时间为(8±3.2)d,Scr恢复正常时间为(6±2.8)d)。肝胰联合移植患者1周内ALT恢复正常并脱离胰岛素治疗。胰肾联合移植患者术后1周内脱离胰岛素治疗,2周内Scr功能恢复正常。所有患者随访至今,存活1～7年,移植物功能正常。结论:采用尸体腹部多器官联合切取技术能快速优质切取肝、脾、肾、以及胰腺和部分十二指肠,缩短热缺血时间,减少动脉损伤,提高腹部多器官联合移植存活。Objective： To explore the optimized technique of abdominal multi-organ procurement and transplantation, and analyze its clinical effects. Methods： From 1999 to 2006, 18 cases of the combined liver-kidney transplantation, 6 cases of the combined pancreas-kidney transplantation and 1 case of combined liver-pancreas transplantation were accomplished successfully in our center. An improved surgical technique, total abdominal evisceration was adopted to harvest donor organs. The modified points were as follows： ①The perfusion of abdominal aorta preceded that of portal vein; ②Liver portal vein perfusion was established via the surgical trunk of the superior mesentery vein （SMV）; ③ Liver, bilateral kidneys, pancreas, duodenum and spleen were harvested en bloc. Results： The average duration of multiple organ harvesting were （16.0±3.0） min, warm ischemic time （2.0±1.2） min. No donor organs and vessels were damaged. The functions of the grafts recovered well. No primary no-function and severe biliary complications occurred in patients who received liver allograft. Normal ALT and Scr achieved （8±3.2）d and （6±2.8）d after operation in liver-kidney transplant patients. ALT in liver-pancreas recipients left off insulin treatment in 1 week and achieved normal Scr in 2 weeks after operation. Recipient returned in normal range and became free from insulin. C onclusions： Total abdominal evisceration is a method to harvest organ rapidly and safely, ensuring good quality of allograft.

关 键 词：多器官联合切取 肝移植 肾移植 胰腺移植 联合移植 

分 类 号：R617[医药卫生—外科学]