心脏死亡器官捐赠应用于腹部多器官移植二例  

Donation after cardiac death used in abdominal multiple visceral organ transplantation

作　　者：胡安斌[1] 何晓顺[1] 欧阳杰[1] 李强[1] 朱晓峰[1] 

机构地区：[1]中山大学附属第一医院器官移植科,广州510080

出　　处：《中华器官移植杂志》2012年第11期651-653,共3页Chinese Journal of Organ Transplantation

基　　金：基金项目：国家自然科学基金（81172831,30700398,30972951,81170448）;国家高技术研究发展计划（“863”计划）项目（2012AA21008）;卫生部部属（管）医院临床学科重点项目（2010159）;公益性行业科研专项基金（201002004）;广东省科技攻关计划（200913030801126,2011A030400005,201213031800257）;广东省自然科学基金（10151008901000200）;教育部高校基本科研业务一中山大学青年教师培育项目（09ykpy28）

摘　　要：目的探讨心脏死亡器官捐赠（DCD）应用于腹部多器官移植的可行性及疗效。方法2例乙型肝炎肝硬化、肝癌合并2型糖尿病患者接受保留自身胰腺的多器官（肝、胰和十二指肠）移植，供者为符合“中国心脏死亡器官捐献分类标准”中的中国三类（C-Ⅲ类）标准的2例男性捐献者。采取多器官联合切取法完整切取供者的肝脏、胰腺、十二指肠和部分空肠，利用供者的髂外、髂内动脉将供者的腹腔干和肠系膜上动脉成型为一个出口，与受者的腹主动脉行端侧吻合。受者的胰腺不切除，其门静脉与移植物的门静脉后壁行端侧吻合，供者的十二指肠降部与受者的上段空肠行侧侧吻合。结果2例的丙氨酸转氨酶、天冬氨酸转氨酶及胆红素总量等肝功能指标在术后2周达正常水平；术后7d血糖恢复正常；术后4d血淀粉酶和脂肪酶恢复正常；术后1～2周空腹血C-肽和胰岛素达正常范围。1例术后出现肠吻合口瘘，经穿刺引流，4周后痊愈。2例受者分别在术后8周和5周康复，肝功能及胰腺功能正常，未再使用胰岛素。结论符合C-Ⅲ类DCD供者的器官可用于腹部多器官移植，术后移植物功能良好。Objective To evaluate the therapeutic effect of abdominal multiple visceral organ transplantation for hepatic cirrhosis combined with diabetes by using donation after cardiac death （DCD）. Methods Two patients suffering from hepatitis B-related liver cirrhosis, hepatocellular carcinoma combined with insulin dependent type 2 diabetes mellitus were given multiple visceral organ transplantation from May to June 2012. The transplanted organs including the liver, pancreas and duodenttm were obtained from two donors after cardiac death which accorded with C-Ⅲ criteria The donor internal and external iliae arteries were anastomosed to celiac axis and superior mesenterie artery and then the donor arteria iliaca commtmis was anastomosed to recipient abdominal aorta. The portal vein reconstruction was performed by end-to-side anastomosis between the donor and recipient portal vein. The pancreatic juice drainage was achieved by side to side anzstomosis between donor duodenum and recipient jejunum. The pancreases of recipients were retained. Results The alanine aminotransferase, aspartate aminotransferase and total bilirubin of two patients were recovered to nolmal level at 2nd week after operation. The blood glucose and serum amylase returned to normal levels at 7th d and 4th d respectively. The fasting serum C- peptide and insulin were also at normal level at 2nd week. One patient with local intestinal armstomotic fistula was given percutaneons puncture drainage for four weeks and recovered. One patient recovered smoothly one month after transplantation without surgical complications. Conclusion Abdominal multiple visceral organ transplantation is an effective treatment for hepatic cirrhosis combined with diabetes by using DCD donor.

关 键 词：心脏死亡 供者 肝硬化 糖尿病 肝移植 胰腺移植 

分 类 号：R617[医药卫生—外科学]