半离体自体小肠移植用于肠系膜根部区域肿瘤伴血管侵犯患者的临床价值  

Clinical value of semi-ex vivo intestinal autotransplantation for patients with mesenteric root regionaltumorsaccompanied byvascularinvasion

作　　者：游欣雨 庞北川 程东辉 左邦佑 蒋佶朋 郝建杰 刘涛 张宇[1] You Xinyu;Pang Beichuan;Cheng Donghui;Zuo Bangyou;Jiang Jipeng;Hao Jianjie;Liu Tao;Zhang Yu(Department of Hepatobiliary and Pancreatic Surgery,Sichuan Academy of Medical Sciences&Sichuan Provincial People's Hospital,Affiliated Hospital of University of Electronic Science and Technology of China,Chengdu 610072,China;Clinical Medicine Class of 2021,School of Medicine,University of Electronic Science and Technology of China,Chengdu 611731,China)

机构地区：[1]四川省医学科学院·四川省人民医院电子科技大学附属医院肝胆胰外科,成都610072 [2]电子科技大学医学院临床医学院,成都61173

出　　处：《中华消化外科杂志》2023年第11期1361-1366,共6页Chinese Journal of Digestive Surgery

基　　金：国家自然科学基金(82373189);四川省科学技术厅科技计划项目(2021YFS0375);四川省科技厅重点研发基金资助项目(2022YFS0596)。

摘　　要：目的探讨半离体自体小肠移植(IATx)用于肠系膜根部区域肿瘤伴血管侵犯患者的临床价值.方法采用回顾性描述性研究方法.收集2021年9月至2022年12月四川省医学科学院·四川省人民医院收治的6例行半离体IATx患者的临床病理资料;男4例,女2例;年龄为(47±21)岁.观察指标:(1)手术情况.(2)术后情况.(3)随访情况.正态分布的计量资料以x±s表示.计数资料以绝对数表示.结果(1)手术情况.6例患者顺利完成半离体IATx.6例患者手术时间为(10.2±2.1)h、热缺血时间为(2.3±1.6)min、冷缺血时间为(49.2±15.6)min、术中输血量为(707±263)mL.6例患者中,3例术中行冷冻威斯康星大学保存液(UW液)灌注,3例术中未行UW液灌注.(2)术后情况.6例患者术后病理学检查结果显示:4例为胰腺导管腺癌,1例为胆管腺癌,1例为肠系膜纤维瘤病.6例患者手术切缘均为阴性,术后住院时间为(19±4)d.6例患者术后均未出现胃肠道出血及吻合口瘘,自体移植肠道功能良好.6例患者围手术期无死亡,出院后无需静脉补液.(3)随访情况.6例患者均获得随访,随访时间为(12±5)个月.6例患者中,仅1例肠系膜纤维瘤病患者术后第7个月复发,其余5例患者无复发、转移.6例患者中,4例出现慢性腹泻,口服罗哌丁胺、双歧杆菌及胰酶胶囊后症状缓解.6例患者均生存.结论半离体IATx用于治疗肠系膜根部区域肿瘤伴血管侵犯患者安全、可行,近期疗效良好.Objective To explore the clinical value of semi-ex vivo intestinal autotransplantation(IATx)for patients with mesenteric root regional tumors accompanied by vascularinvasion.Methods The retrospective and descriptive study was conducted.The clinicopathological data of 6 patients who underwent semi-ex vivo IATx in the Sichuan Academy of Medical Sciences&Sichuan Provincial People's Hospital from September 2021 to December 2022 were collected.There were 4 males and 2 females,aged(47±21)years.Observation indicators:(1)surgical conditions;(2)postoperative conditions;(3)fllow-up.Measurement data with normal distribution were represented by Mean+SD.Count data were represented by absolute numbers.Results(1)Surgical conditions.All 6 patients completed semi-ex vivo IATx successfully.The operation time,warm ischemia time,cold ischemia time,volume of intraoperative blood transfusion were(10.2±2.1)hours,(2.3±1.6)minutes,(49.2±15.6)minutes,(707±263)mL.0f the 6 patients,3 patients were intraoperatively perfused with cold UW solution,while the other 3 were not.(2)Postoperative conditions.Results of postoperative pathological examination of the 6 patients showed 4 cases of pancreatic ductal adenocarcinoma,1 case of cholangiocarcinoma,and 1 case of mesenteric fibromatosis.All 6 cases had negative surgical margins and the duration of postoperative hospital stay was(19+4)days.None of the patient had gastrointestinal bleeding or anastomotic leakage postoperatively,and the autotransplanted intestine functioned well.There was no perioperative death,and intravenous rehydration was not required after discharge.(3)Follow-up.All 6 patients were followed up for(12+5)months.Only 1 patient with mesenteric fibromatosis had recurrence in the 7th month postoperatively,while the remaining 5 patients showed no sign of recurrence or metastasis.There were 4 of 6 patients with chronic diarrhea.They were improved after oral loperamide,bifidobacterium and pancreatin capsules.All 6 patients survived.Conclusion Semi-ex vivo IATx for the treatment of

关 键 词：自体小肠移植 腹腔肿瘤 血管重建 治疗 手术 疗效 

分 类 号：R656.7[医药卫生—外科学]