胸腹腔器官簇联合切取技术的临床应用  

Combined resection of thoracic and abdominal organ clusters:a series of 50 cases

作　　者：李斯林 孙煦勇 秦科[1] 文宁 廖吉祥 蓝柳根[1] 黄莹[1] 雷志影 苏庆东 吴基华[1] Li Silin;Sun Xuyong;Qin Ke;Wen Ning;Liao Jixiang;Lan Liugen;Huang Ying;Lei Zhiying;Su Qingdong;Wu Jihua(Transplant Medical Center,the Second Affiliated Hospital of Guangxi Medical University,Nanning 530007,China)

机构地区：[1]广西医科大学第二附属医院移植医学中心,南宁530007

出　　处：《中华外科杂志》2022年第8期774-778,共5页Chinese Journal of Surgery

基　　金：国家自然科学基金(81670596)。

摘　　要：目的探讨胸腹腔器官簇联合切取技术的操作方法及其效果。方法回顾性分析2019年2月至2021年8月广西医科大学第二附属医院移植医学中心完成的50例胸腹腔器官簇联合切取的临床资料。供者均为公民逝世后国际标准化脑死亡器官捐献(DBD), 男性47例, 女性3例, 年龄(34.8±12.3)岁(范围:5~55岁), 住院时间[M(IQR)]4(4)d(范围:2~43 d), 气管插管时间4(2)d(范围:1~43 d)。取经胸骨正中及腹部大"十"字切口, 分别建立各靶器官的灌注管路后同期进行冷灌注, 以膈肌为界, 以器官簇为单位进行联合灌注及切取。现场完成心、肺分离后分别送往移植医院, 腹部器官簇则直接保存送回广西医科大学第二附属医院行进一步分离和修整。结果共获取心脏21个, 肺脏47对, 肝脏49个, 肾脏47对, 胰腺11个, 切取时间(32.6±6.5)min(范围:19~50 min), 无热缺血时间, 未出现影响器官质量和功能的手术副损伤。顺利完成心脏移植17例, 心肾联合移植2例, 双肺移植43例, 单肺移植6例, 肝移植41例, 肝胰十二指肠器官簇联合移植1例, 肝肾联合移植3例, 胰肾联合移植9例, 肾移植74例。结论对DBD供者进行胸腹腔器官簇同期灌注、联合切取具有可行性和有效性。Objective To examine the technique and effect of combined thoracic and abdominal organ clusters resection.Methods From February 2019 to August 2021,totally 50 cases of combined thoracoabdominal organ cluster resection were completed at Transplant Medical Center,the Second Affiliated Hospital of Guangxi Medical University from donation after brain death donors.There were 47 males and 3 females,aging(34.8±12.3)years(range:5 to 55 years).The length of hospital stay(M(IQR))was 4(4)days(range:2 to 43 days),the length of tube time was 4(2)days(range:1 to 43 days).Through the midsternal incision and the abdominal grand cross incision,the cold perfusion was performing simultaneously when the perfusion lines of each target organ was established respectively.The combined resection was performed with the diaphragm as the boundary and the organ cluster as the unit.The heart and lung were separated on site and sent to the transplant hospital,and the abdominal organ cluster was directly preserved and returned to our hospital for further separation and repair.Results Totaly 21 hearts,47 pairs of lungs,49 livers,47 pairs of kidneys and 11 pancreas were harvested by this surgical treatment.The resection time was(32.6±6.5)minutes(range:19 to 50 minutes),with no hot ischemia time.There was no accidental injury that affected organ quality and function.Heart transplantation was performed in 17 cases,combined heart-kidney transplantation in 2 cases,double lung transplantation in 43 cases,single lung transplantation in 6 cases,liver transplantation in 41 cases,combined liver-pancreas-duodenal cluster transplantation in 1 case,combined liver-kidney transplantation in 3 cases,combined pancreas-kidney transplantation in 9 cases,and kidney transplantation in 74 cases.Conclusion Simultaneous perfusion and combined resection of thoracic and abdominal organ clusters for donation after brain death donors are feasible and effective.

关 键 词：器官移植 组织和器官获得 器官保存 胸腹腔器官 

分 类 号：R655[医药卫生—外科学]