Intestinal autotransplantation  

肠道自体移植

作　　者：Guosheng Wu 

机构地区：[1]Xijing Hospital of Digestive Diseases,The Fourth Military Medical University,Xi’an,Shaanxi,China

出　　处：《Gastroenterology Report》2017年第4期258-265,I0001,共9页胃肠病学报道（英文）

基　　金：This work is supported by the grant from the National Natural Science Foundation of China(#81570588).

摘　　要：Most abdominal neoplasms involving the root of the superior mesenteric artery and/or celiac artery are difficult to manage with conventional operative techniques because of limited intestinal ischemia times and poor accessibility to the tumor region.Ex vivo surgery followed by intestinal autotransplantation(IATx)is a relatively novel surgical strategy to offer chances for complete resection in such hopeless circumstances.This review aims to assess potential surgical indications,operative techniques and clinical outcomes after IATx.Currently the main indications reported for IATx broadly include pancreatic,mesenteric and retroperitoneal neoplasms closely involving the superior mesenteric vessels.The preliminary results show that radical resection can be effectively achieved in carefully selective patients.Although perioperative morbidity and mortality are relatively high,there are several long-term survivors,particularly after complete resection of benign and low-grade tumor.Early tumor recurrence,however,remains a major problem in patients with high-grade tumor,particularly pancreatic ductal carcinoma.In conclusion,IATx allows patients with selected abdominal neoplasms involving themajormesenteric vessels to be completely resected.However,this aggressive approach is associated with a considerable operative risk,and should only be performed at experienced centers.Additional and adjunctive treatment therapies are required to improve the efficacy of this treatment.大多数累及肠系膜上动脉根部和/或腹主动脉的腹部肿瘤难以通过传统的外科手术进行切除,因为肠缺血时间有限且肿瘤区域难以完全暴露。体外手术后自体移植(IATx)是一种相对较新的外科技术,能在这些根治无望的情况下提供一个肿瘤完全切除的机会。本文旨在评估IATx的潜在适应证、手术技术及临床疗效。目前报道的IATx主要适应证包括侵犯肠系膜上血管的胰腺、肠系膜及腹膜后肿瘤。初步的结果显示,对于严格筛选的病例,IATx可以获得满意的根治性切除。尽管围手术期并发症发生率和病死率相对较高,仍有部分患者可以获得长期存活,尤其是完全切除的良性或低度恶性肿瘤。而对于高度恶性的肿瘤尤其是胰腺导管癌,术后早期复发仍然是一大难题。总之,IATx可以使部分侵及肠系膜主要血管的腹部肿瘤得以完全切除。然而,这种激进的术式具有相当高的手术风险,目前仅推荐在少数经验丰富的中心开展。另外,也需要配合其他的一些治疗措施以及辅助治疗,以提高IATx的疗效。

关 键 词：Intestinal autotransplantation ex vivo surgery pancreatic cancer mesenteric tumors 

分 类 号：R73[医药卫生—肿瘤]