同种异体肝小肠联合移植(附国内首例报告)  

Combined liver and intestinal transplantation:the first case report in China.

作　　者：李元新[1] 李宁[1] 陈规划[2] 李幼生[1] 朱晓峰[2] 朱维铭[1] 倪小冬[1] 朱亮[1] 曹斌[1] 李为苏[1] 罗开[1] 黎介寿[1] 

机构地区：[1]南京军区南京总医院全军普通外科研究中心,210002 [2]中山大学附属第一医院器官移植中心,广州510080

出　　处：《中国实用外科杂志》2003年第10期595-597,共3页Chinese Journal of Practical Surgery

基　　金：江苏省医学重点人才培养基金资助

摘　　要：目的　报告国内首例同种异体肝小肠联合移植 ,并就肝肠联合移植适应证、排斥诊断与治疗、感染防治、肠功能恢复与营养支持进行讨论。方法　供肠长 380cm ,供肠肠系膜上动脉、门静脉分别与受体腹主动脉、下腔静脉端侧吻合 ;供肝行改良背驮式肝移植。术后免疫抑制剂采用FK5 0 6 +激素 +骁悉 +赛尼哌方案。排斥监测采用内镜指导下肠粘膜活检病理学检查及临床观察。并采取措施防治感染和促进移植肠功能的恢复。结果　病人恢复顺利 ,移植肠和移植肝功能良好 ,未发生排斥反应 ,术后 3个月时已摆脱全肠外营养 ,依靠肠内营养维持营养状态。结论　肝小肠联合移植对肠衰竭合并全肠外营养所致肝功能损害病人 ,是可行、有效的治疗方法。Objective To report the first case of combined liver and intestinal transplantation in China and discuss the indications,diagnosis and treatment of acute rejection,prevention of sepsis,recovery of the graft function and nutritional support in combined liver and intestinal transplantation.Methods The 380cm long intestinal graft was transplanted with systemic drainage and aortic inflow,while the liver graft was placed in a piggyback fashion.Immunosuppression management included tacrolimus,methylprednisolone,cellcept and Zenapax.Endoscopic guided mucous biopsy of the intestinal graft and clinical observation were done to monitor the acute rejection.Measures of sepsis prevention and improvement of graft function were also taken.Results The recipient recovered with good function of the two grafts.No evidence of rejection was observed.He could do without TPN 3 months after transplantation,by living on tube feeding.Conclusion Combined liver and intestinal transplantation is a feasible and effective optimal clinical choice for patients with irreversible intestinal failure and TPN-related liver damage.

关 键 词：同种异体 肝移植 小肠移植 联合移植 营养支持 肝功能衰竭 肠衰竭 

分 类 号：R657.3[医药卫生—外科学] R656.7[医药卫生—临床医学]