尸体腹部多器官联合切取(TAE)技术的改进及临床应用  

Improved surgical technique of total abdominal evisceration (TAE) and its clinical practice

作　　者：于立新[1] 刘小友[1] 徐健[1] 徐达传[2] 马俊杰[1] 付绍杰[1] 邓文锋[1] 杜传福[1] 王亦斌[1] 叶桂荣[1] 姚冰[1] 苗芸[1] 

机构地区：[1]第一军医大学南方医院肾移植科 [2]第一军医大学解剖学教研室,广东广州510515

出　　处：《中国临床解剖学杂志》2002年第5期388-390,共3页Chinese Journal of Clinical Anatomy

摘　　要：目的 :探讨尸体多器官联合切取的最佳方法。方法 :1998～ 2 0 0 2年采用改进后的多器官联合切取技术进行了 65例次多器官联合切取术 ,主要改进点有 :①采用纱布填塞导尿管内腔用以灌注腹主动脉 ;②气囊注水 ,堵塞腹主动脉上段 ;③回血由下腔静脉肾静脉开口以下引入 3升袋内 ;④优先灌注腹主动脉而后灌注肝门静脉 ;⑤体内整块切取肝、胰、脾、肾、十二指肠等器官。结果 :建立腹主动脉灌注的时间为(1.0± 0 .3 )min ,建立肝门静脉灌注的时间为 (1.0± 0 .7)min ,腹腔多器官联合切取时间为 (10 .0± 3 .0 )min ,热缺血时间 (2 .0± 1.2 )min。本院行肝移植 4例 ,肝肾联合移植 2例 ,供外院行肝移植 12例 ,所有肝移植病人肝功能在 3周内恢复正常 ;胰肾联合移植 1例 ,术后 2周脱离胰岛素和透析治疗 ;肾移植 12 7例 ,术后肾功能恢复时间 (4 .82± 3 .73 )d ,急性肾小管坏死 4例 (3 .2 % )。结论 :优先灌注腹主动脉优于优先灌注肝门静脉 ;改进后的尸体腹部多器官联合切取技术能快速优质切取供器官 ,适于临床推广使用。Objective: To explore the best method of total abdominal evisceration (TAE). Methods: From 1997 to 2002, an improved surgical technique of total abdominal evisceration had been carried out for 65 times, and the main modified points were as follows: ① The inside cavity of catheter used to lavage abdominal aorta was blocked by pledget; ②Air pocket enlarged by infusion of water was used as blockade of upper segment of abdominal aorta; ③The abdominal inferior vein cava was dissected out below the opening of renal vein to cannulate and decompress the abdominal system; ④The perfusion of abdominal aorta preceded that of portal vein;⑤ Underwenting en bloc resection of organs of bilateral kidneys, pancreas, duodenum, liver and spleen .Results: The procedure of establishing perfusion of abdominal aorta and portal vein took 1.0±0.3 and 1.0±0.7 minutes respectively .The time of multiple organ harvesting and warm ischemic were 10.0±3.0 and 2.0±1.2 minutes respectively. Four liver transplantations (LT) and 2 combined liver-kidney transplantations performed in our center, and twelve LTs performed in other transplantation centers. The functions of grafted liver recovered normally within 3 weeks. We also have successfully finished 127 cases of kidney transplantations (KT) and 1 case simultaneous kidney-pancreas transplantation (SPKT). The patients performed SPKT escaped hemodialysis and insulin therapy within 2 weeks. In KT group, normalization time of renal function was 4.28±3.73 days and the incidence rate of acute tubular necrosis (ATN) incidence was 3.2%. Conclusion: Quality organs can be procured rapidly by the improved surgical technique of total abdominal evisceration.

关 键 词：器官移植 多器官联合切取 灌洗 临床应用 

分 类 号：R617[医药卫生—外科学]