脱细胞异体真皮基质材料辅助关腹预防全小肠移植受者腹内高压一例  

Acellular dermal matrix prevents intra--abdominal hypertension for abdominal wall closure following small bowel transplantation： A case report

作　　者：倪小冬[1] 李幼生[1] 毛琦[1] 王剑[1] 姚丹华[1] 黎介寿[1] 

机构地区：[1]南京军区南京总医院普通外科,210002

出　　处：《中华器官移植杂志》2016年第3期150-153,共4页Chinese Journal of Organ Transplantation

基　　金：国家自然科学基金（81270945）

摘　　要：目的探讨脱细胞异体真皮基质（ADM）材料辅助关腹预防肠移植受者腹腔高压的效果。方法回顾分析1例男性小肠移植受者术中使用脱细胞异体真皮基质材料辅助关腹的临床资料。选用2片12cm×20cm大小的ADM补片，盐水浸泡活化，展平铺在腹膜下，用可吸收缝线将ADM补片间断贯穿缝合固定，剪除多余的ADM补片。放置皮下负压引流管于腹直肌鞘上方，间断缝合皮肤关腹。结果术后受者第18h停用呼吸机恢复自主呼吸，膀胱压均不高于7cmH2O（1cmH2O=0．098kPa），移植物功能恢复良好，术后第6天开始肠内营养，腹部切口无裂开及感染。术后第19天因腹腔内积液及脓肿形成再次手术时未见补片感染。结论在小肠移植中采用ADM辅助关腹可有效降低腹内压，未见感染及移植物功能丧失的发生，短期效果良好。其远期效果有待进一步的观察和研究。Objective To investigate the effect of acellular dermal matrix （ADM） for abdominal closure to prevent abdominal high pressure after intestinal transplantation. Method ADM was used for abdominal closure following intestinal transplantation in a 17-year-old man with ultra-short bowel syndrome. Two ADMs with 12 cm 20 cm were reconstituted intraoperatively with warm sterile normal saline. After flattened under peritoneum, the ADM was pruned and then sewn to the muscular layer of abdominal wall by interrupted transfixing suture with absorbable suture. A negative pressure drainage tube was placed over an area of native fascia in the subcutaneous space. Skin and soft tissues were closed by interrupted suture. Result The intra-abdominal pressure was not higher than 7 emH2O90 h post-operation The ventilator has been withdrawn 18 h after operation. Enternal nutrition was given from postoperative day 6. He required surgical exploration for abdominal abscess on the postoperative day 19. The ADM closely adhered to the abdominal wall and no abscess in abdomen was related to ADM. Conclusion ADM can be safely used for abdominal closure and effectively prevent intra- abdominal high pressure in this intestinal transplantation. No infection or graft loss occurred in the early postoperative period. More observations are needed to study the long-term results and complications in the future.

关 键 词：脱细胞异体真皮基质 小肠移植 关腹 腹内高压 

分 类 号：R656.7[医药卫生—外科学]