同种异体手、拇指移植临床报告  

Human hand and thumb allografts-a cases report

作　　者：赵劲民[1] 杨志[1] 苏伟[1] 韦庆军[1] 花奇凯[1] 阳富春[1] 丁晓飞[1] 白鹤[1] 苏方荣[1] 毕剑恒[1] 李秀霞[1] 郑小敏[1] 

机构地区：[1]广西医科大学第一附属医院创伤骨科,手外科,南宁530027

出　　处：《中华创伤杂志》2002年第6期353-356,共4页Chinese Journal of Trauma

摘　　要：目的　探讨、总结同种异体肢体移植的可行性和临床经验。　方法　选择 2例ABO、Rh血型相同 ,不同侧别手、拇指缺失的患者作为移植对象 ,与同一供体配型 ,确定合适供体。供体双上肢无菌条件下肘关节离断 ,4℃肝素等渗盐水经肘动脉灌注 ,低温保存。移植手术与自体断腕、断指再植手术过程相似 ,不同点在于术中优先吻合桡动脉 ,静脉端放血 ,利用受体自身血再次灌注。术后常规抗感染、抗凝、抗痉挛治疗和抗排斥反应治疗。　结果　移植手、拇指术后经过顺利 ,伤口术后 4周拆线。术后 12个月 ,未发生明显排斥反应 ,移植手、拇指血循环、皮肤温度、颜色与正常对侧相同 ,感觉已恢复到指尖 ,而且可以持物 ,功能满意。　结论　严格术前准备 ,合理术后用药 ,异体手、拇指移植是可行的 。Objective To study and summarize the feasibility and the clinical experience of human hand and thumb allografts. Methods Two male recipients with same ABO and Rh blood type were used. One patient with traumatic left hand defect and another with traumatic right thumb defect were matched respectively with a donor died of cerebral injury on blood types ABO and Rh. The suitable compatibility on blood types ABO and Rh was confirmed each other. Both upper extremities of the donor along elbow joint level were amputated and irrigated with heparin saline at 4℃ via elbow arteria thoroughly then put into an ice box. The transplantation procedure was similar to that of autologous replantation of severed hand and thumb. As an important step, the radial artery was anastomosed at first and then the blood was gushing out by the vein end as well the allografts were irrigated with the receptor's blood. After surgery, the patients were given wide spectrum antibiotics, anticoagulation, antispasm agents and immunosuppressants. Results The postoperative recovery of the allografts was successful. The stitches of wound were taken out at the 4th postoperative week. At the 12th month after the surgery, circulation, skin temperature and color of the transplanted hand and thumb were similar to that of another normal side. The transplanted left hand and right thumb could hold things and the esthesia had reached the finger tip. Conclusions Human hand and thumb allografts are feasible by strict preoperative preparation and reasonable postoperative medication. The early effect and function recovery are satisfactory.

关 键 词：手损伤 指损伤 移植物排斥 同种异体移植 

分 类 号：R658.1[医药卫生—外科学]