活体小肠移植的历史、现状与未来  

Living-Donor Intestinal Transplantation:Past,Present and Future

作　　者：吴国生 Wu Guosheng(Department of Colorectal Surgery and Intestinal Transplant Center,the First Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou 310003,China)

机构地区：[1]浙江大学医学院附属第一医院结直肠外科小肠移植中心,杭州310003

出　　处：《中华器官移植杂志》2024年第4期243-250,共8页Chinese Journal of Organ Transplantation

基　　金：国家自然科学基金(82170662);浙江省卫生高层次领军人才基金(G25219);浙江省自然科学基金重大项目(LD21H03000)。

摘　　要：小肠移植是救治肠功能衰竭患者的重要手段。活体小肠移植是将健康捐献者的部分小肠切除移植给受者,该方法具有器官缺血时间短、组织相容性好、排斥反应低以及术前准备充分等优势。目前全球共施行此类手术超过100例,受者和器官存活率优于遗体捐献小肠移植、中远期存活率等同于家庭肠内营养,而受者生存质量更有优势。随着经验积累和技术提高,活体小肠移植已经成为肠衰竭患者的重要治疗选择,如家庭肠外营养(home parenteral nutrition,HPN)治疗失败,小肠移植是挽救患者生命的唯一手段。本文进一步阐明小肠移植排斥反应的发生机制,探讨敏感性、特异性强的早期肠功能监测新技术、进一步研究防治抗体介导的排斥反应的新方法、阐明肠道菌群与预后的关系以及降低小肠的缺血再灌注损伤,对于提高小肠移植的远期疗效意义重大。Intestinal transplantation(ITx)is currently a vital life-saving strategy for patients with irreversible intestinal failure.Living donor intestinal transplantation,procuring segmental intestinal graft usually from healthy close relatives,offers several advantages over deceased donation,including well-planned procedures,shorter ischemic duration,optimized tissue matching and lower rejection rates.Intestinal transplantation has been performed most commonly using deceased donation.Approximately 2%of intestinal transplantation(slightly over 100 cases)was harvested from living donation.Preliminary results indicated that graft and recipient survivals after living donation were superior to those after intestinal transplantation from deceased donation.Mid/long-term recipient survivals were equal to those undergoing home parenteral nutrition(HPN).With richer experiences and greater advances in surgical techniques,living donor intestinal transplantation has been becoming a sole therapeutic choice for chronic intestinal failure and a mere life-saving maneuver in some instances.Better understanding the mechanisms of triggering rejection,exploring a novel non-invasive method for detecting early intestinal damage,further establishing surgical indications for living donor intestinal transplantation and lowering postoperative complications are critical for achieving better long-term outcomes.

关 键 词：小肠移植 活体小肠移植 预后 

分 类 号：R656[医药卫生—外科学]