心脏死亡幼儿供肝移植治疗幼儿胆道闭锁一例  

Successful liver transplantation for infant＇with biliary astresia by using liver graft from infant donor aftercardiac death

作　　者：张明满[1] 戴小科[1] 郭春宝[1] 蒲从伦[1] 李英存[1] 康权[1] 任志美[1] 邓玉华[1] 熊强[1] 陈柏林[1] 胡键阳[1] 陈凯[1] 

机构地区：[1]重庆医科大学附属儿童医院,400014

出　　处：《中华器官移植杂志》2012年第12期728-731,共4页Chinese Journal of Organ Transplantation

摘　　要：目的总结心脏死亡幼儿供肝移植治疗幼儿先天性胆道闭锁的体会。方法供者为女孩，年龄16个月，体重10kg，因严重缺氧性脑病继发心脏死亡行器官捐赠；受者为女孩，年龄2岁，体重12kg，因先天性胆道闭锁行肝门-空肠吻合术，术后出现黄疸并发胆汁性肝硬化晚期。肝移植手术采用经典肝移植术式，供肝热缺血时间为7min，冷缺血时间为360min，移植物与受者标准肝体积比（GV／SLV）为1．02。术后严格监测受者的生命体征和移植肝功能，积极进行抗感染、抗凝血，改善微循环等护理措施，采用他克莫司、吗替麦考酚酯和泼尼松的三联免疫抑制方案预防排斥反应。结果受者手术耗时480min，无肝期65min，术中出血230ml。受者于术后12h拔除气管插管，48h开始进食。术后3和15d时，受者出现肝动脉血栓形成，用介入法经肝动脉插管持续灌注尿激酶溶栓等治疗后肝动脉恢复血流，移植肝功能逐渐恢复正常，术后42d时出院，健康生活至今。结论心脏死亡肝供幼儿可以成为婴幼儿肝移植的供肝来源，并获得良好的肝移植效果；供、受者肝脏体积的匹配可以减少手术并发症的发生；熟练的显微外科技术和围手术期精细的管理是手术成功的保证。Objective To summarize the clinical experience of successful liver transplantation from infant donation after cardiac death （I）CD） for infant with biliary astresia （BA）. Methods The donor was a 16-months-old girl with a body weight of 10 kg, who died of irreversible anoxic cerebral damage after sudden asphyxiation. The recipient was a 24-months-old girl with a body weight of 12 kg, who suffered from icteric concurrent late biliary cirrhosis after the Porta-jejunum anastomosis because of congenital BA. The DCD liver was classically orthotopically transplanted into the infant＇s recipient. The warm ischemia time was 7 min, the cold ischemia time was 360 min, and the graft volume to the standard liver volume （GV/SLV） was 1.02. After operation, the vital signs and transplanted liver function of the recipient were monitored, and the recipient was given treatments of anti-infection, anticoagulation, and improving the microcirculation. The recipient was treated with the triple immunosuppression protocol of tacrolimus, mycophenolate and prednisone to prevent rejection. Results The operating time of the recipient was 480 min, the non-liver stage was 65 min, and the blood loss was 230 mL. The endotracheal intubation was removed from the recipient at 12 h, and the recipient started to eat at 48 h after operation. The recipient had a hepatic artery thrombus on the 3rd and 15th day after operation, and the hepatic artery had re-blood-supply after the hepatic artery catheterization and continuous perfusion with urokinase. The recipient was discharged on the 42nd day, and the recipient was in satisfactory condition to present. Conclusion The infant DCD liver is a better graft for infant liver transplantation for BA. The surgical complications can be reduced with matched volume of donor-recipient liver; and it can guarantee a successful operation with perfect operative technique and careful perioperative management.

关 键 词：幼儿 心脏死亡 组织供者 肝移植 

分 类 号：R726.5[医药卫生—儿科]