母子亲体小肠移植治疗小肠衰竭的方法及疗效探讨:附1例报告

Method and outcome of living-related small bowel transplantation on intestinal failure:a case report

目的探讨母子亲体小肠移植的方法及其对短肠综合征所致小肠衰竭的疗效。方法为1名15岁短肠综合征(仅残留小肠8cm)致小肠衰竭的男患者行小肠移植术。供体为患者母亲。取供体带血管蒂回肠中下段1.2m移植于受体腹腔,两端分别造瘘及作人工肛。二期手术于6个月后施行,将受体残余肠中部横断,上下端分别与供肠近、远段行端侧吻合。结果供、受体手术顺利。受体一期手术后曾发生感染及排斥,经治疗后痊愈。二次术后随访8个月,受体小肠功能逐渐恢复,患者体重明显增加,一般情况好,进食半流质,生活能自理。结论亲体小肠移植是治疗短肠综合征肠衰竭的有效方法。排斥和感染是威胁小肠移植安全的主要因素。

Objective To analyze the surgical procedure and effect of living-related small bowel transplantation （LR-SBTx） on intestinal function failure caused by short bowel syndrome. Methods A boy, 15 years of age with short gut syndrome, who had only 8 cm of residual small intestine, associated with serious malnutrition and poor D-xylase absorption test （0. 226/5h ）. The donor was the boy＇s mother. They had a match of 4 loci in HLA. In the first stage of the surgical procedure, 120 cm of ileum from the patient＇s mother was transplanted into the recipient. Both ends of the transplanted intestine were exteriorized as stomas on the patient＇s abdominal wall. The second stage of reconstruction of the intestine was carried out 6 months after his first operation. The residual small bowel of the recipient was transected, and both of its ends were respectively anastomosed end-to-side to the proximal and distal segments of the graft. The stomas of the graft were left in place. Results The donor and recipient operation went on smoothly. Acute rejection and infection of CMV developed postoperatively and were cured after treatment. The patient was followed-up for 8 months, the graft function recovered gradually postoperatively with increase of body weight. He can ingest a semifluid diet and take care of himself independently. Conclusions LR-SBTx is an effective way to treat short bowel syndrome. The reconstruction of the intestine in two stages for LR-SBTx decreased the risk of complications. Rejection and infection are important risk factors of LR-SBTx.