改良腹腔多器官簇移植外科技术:临床应用前的大动物实验

Surgical techniques of modified multivisceral transplantation:preclinical surgical technique preparation in big animals

目的通过大动物实验,施行改良腹腔多器官簇移植外科技术,训练手术团队,为临床开展改良腹腔多器官簇移植做技术准备。方法选用杂交长白猪作供受体。高渗枸橼酸盐腺嘌呤液经腹主动脉原位灌注,整块切取胃、十二指肠、小肠和胰腺器官簇。血管重建是将移植物的腹主动脉远侧端与受体肾下腹主动脉作端侧吻合,将移植物门静脉与受体肠系膜上静脉残端作端端吻合。消化道重建采用受体十二指肠残端侧侧吻合于移植物的近侧空肠,移植胃前壁、移植小肠末端拖出腹壁造口作观察窗用。结果 25例次供体切取手术中18例次成功完成,平均手术时间为(149.44±22.09)min。在没有完善的围麻醉期和围手术期支持条件下,18例次受体手术顺利完成12例次,平均手术时间(236.67±36.76)min,移植物平均冷缺血时间(212.92±21.26)min。12例存活2～126h,其中7例存活超过24h(2例超过72h,1例达126h)。结论猪改良腹腔多器官簇移植实验表明这一技术在临床上是可行的。

Objective In order to successfully perform modified multivisceral transplantation(MMVTx) in human being,we tried to perform surgical techniques of MMVTx on pigs,in an attempt to train a team of transplant surgeons.Methods Donor organs were infused with hypertonic citrate adenine solution in situ and a cluster of grafts including stomach,duodenum,pancreas and intestine were recovered en bloc.The donor’s infra renal aorta was anastomosed with the recipient’s infra renal aorta in an end-to-side fashion,and an end-to-end anastomosis between the donor’s portal vein and the recipient’s superior mesenteric vein was performed.Side-to-side anastomosis between the native duodenum and the graft jejunum was preformed.A covering distal loop ileostomy and a gastrostomy were created for surveillance.Results Eighteen clusters of the MMVTx grafts were successfully procured from 25 donors;the mean operative time of harvesting was(149.44±22.09) min.In the absence of appropriate support during peri-anesthetic period and peri-operative period,12 surgical procedures of 18 MMVTx were successfully performed,and the survival time of these 12 recipients was from 2 to 126 h.Seven of the 12 recipients survived more than 24 hours,2 of which survived more than 72 h and 1 survived 126 h.The mean operative time of recipients was(236.67±36.76) min and the cold ischemia time was(212.92±21.26) min.Conclusion Our successful MMVTx surgical techniques in pigs indicated that these techniques were feasible in human being.