简化式腹部多器官移植手术技术探讨22例  

Surgical techniques of simplified abdominal multiple organs transplantation

作　　者：鞠卫强[1] 林建伟[1] 王东平[1] 马毅[1] 巫林伟[1] 邰强[1] 郭志勇[1] 韩明[1] 王小平[1] 陈茂根[1] 朱晓峰[1] 何晓顺[1] 

机构地区：[1]中山大学附属第一医院器官移植中心,广州510080

出　　处：《中华器官移植杂志》2015年第7期385-388,共4页Chinese Journal of Organ Transplantation

基　　金：广东省器官捐献与移植免疫重点实验室建设项目（2013A06140l007）;公益性行业科研专项基金（201302009）

摘　　要：目的 探讨简化式腹部多器官移植治疗终末期肝病合并糖尿病的相关技术.方法 分析总结22例简化式腹部多器官移植受者的手术过程及临床资料.22例受者的原发病分别为肝细胞癌11例,乙型肝炎后肝硬化9例,胆管细胞癌和胆汁性肝硬化各1例.受者术前肝功能Child-Pugh分级为A级2例、B级14例及C级6例,终末期肝病模型评分为（7.8±4.1）分.所有受者均合并有2型糖尿病,病程为（4.8±3.8）年,均使用胰岛素控制血糖,术前糖化血红蛋白为7.5％±1.5％,C肽为（0.66±0.35） nmol/L.术中保留受者胰腺和全消化道,单纯切除肝脏后,行简化式腹部多器官（包括肝、胰、十二指肠降部和水平部）移植.术后检测肝功能、肾功能、血糖、C肽等指标,监测感染、排斥反应、血管并发症及胆道并发症等发生情况.结果 术后对所有受者进行了中位时间15.0个月（25％位数5.4个月,75％位数37.3个月）的随访,其中21例于术后2周内停用胰岛素,空腹及餐后血糖恢复至基本正常水平.受者术后3个月糖化血红蛋白为4.9％±0.3％,低于术前水平（P＜0.05）;术后3个月C肽为（1.13±0.69） nmol/L,高于术前水平（P＜0.05）.1例于术后10个月复查时仍使用胰岛素控制血糖.术后1周受者丙氨酸转氨酶、天冬氨酸转氨酶及胆红素总量等肝功能指标趋于正常.随访中均未发现胆道并发症.术后1、3、5年累积存活率分别为95.5％、88.1％和88.1％.结论 简化式腹部多器官移植是一项安全、有效的移植新术式,与经典多器官移植术式相比,缩短了手术时间,减少了手术创伤,术后并发症少,恢复快,移植胰腺内分泌功能稳定,受者可获得良好的长期存活及满意的生活质量.Objective To investigate the surgical techniques of simplified abdominal multiple organs transplantation in patients with end stage liver disease and diabetes.Method The clinical data of 22 cases of simplified abdominal multiple organs transplantation were retrospectively analyzed.The primary diseases included liver cirrhosis after hepatitis B （9 cases）, hepatocellular carcinoma （11 cases）, cholangiocellular carcinoma （1 case） and primary biliary cirrhosis （1 case）.All patients were rendered dependent from insulin therapy before transplantation.Duration of diabetes was （4.8 ± 3.8） years.Mean level of glycosylated hemoglobin and C-peptide in all recipients was （7.5 ± 1.5）% and 0.66 ± 0.35 nmol/L respectively before transplantation.The pancreas and the whole digestive tract of the recipients were reserved.The liver and pancreas duodenal organ cluster grafts were implanted after the resection of the diseased liver.The liver and kidney function, blood glucose, C-peptide, infection, rejection, vascular complications, biliary complications and other indicators were monitored postoperatively.Result Median posttransplant follow-up was 15.0 months （1.0 to 78.0 months）.From two weeks after operations, no insulin was used in 21 patients, and the blood glucose levels were returned to almost normal.Mean glycosylated hemoglobin values decreased from pretransplant （7.5 ± 1.5）% to （4.9 ± 0.3）% 3 months posttransplantation （P〈0.05）.Mean C-peptide values increased from pretransplant 0.66 ± 0.35 nmol/L to 1.13 ± 0.69 nmol/L 3 months posttransplantation （P〈 0.05）.There was only one recipient who remained exogenous insulin （24 U/day） dependence 10 months after transplantation.Alanine aminotransferase （ALT）, aspartate aminotransferase （AST） and total bilirubin became normal after 1 week.So far of the followed up, there was no bilary complication.Among the 22 patients, calculated 1 , 2-and 5-year survival rate was currently 95.5%, 88.1 % and 88.1 %, respectively.Conclus

关 键 词：腹部 多器官移植 肝病 糖尿病 

分 类 号：R617[医药卫生—外科学]