短肠综合征合并高位肠瘘患者施行亲属活体小肠移植一例

Living related small bowel transplantation for one patient with short gut syndrome with complication of ileus-colon anastomosis fistulas

目的总结短肠综合征合并高位肠瘘患者施行亲属活体小肠移植的经验和体会。方法为1例因肠系膜上动脉栓塞而切除空肠、大部分回肠及右半结肠的患者施行亲属活体小肠移植，供者为患者之子，移植回肠长度为150cm，供肠热缺血时间1min，冷缺血时间65min。受者切除肠瘘，供肠动、静脉分别与受者的腹主动脉和下腔静脉行端侧吻合，供肠的近端与受者的空肠残端行端端吻合，远端侧壁与结肠残端行侧端吻合，移植小肠末端造口，作为观查窗。术后使用他克莫司、霉酚酸酯和甲泼尼龙预防排斥反应，并给予抗感染、抗凝以及胃肠外为主、肠内营养为辅的支持治疗。结果术后移植小肠功能接近正常，能胜任一般的体力劳动。术后110d，患者因情绪变化突发心脏意外，抢救无效死亡。结论合并肠瘘的短肠综合征并非小肠移植禁忌证，术前充分准备和术后细致观察及管理是成功的关键。

Objective To summarize the experience of management in the living related small bowel transplantation for one patient with short gut syndrome and resection of right colon with complication of ileus-colon anastomosis fistulas. Methods One patient with almost all small bowel and right colon resected for embolism of superior mesenteric artery underwent the living related small bowel transplantation. The segment of 150 cm distal small bowel graft was taken from his son with 1 rain of heat ischemia time and 65 min of cold ischemia time. The ileus-colon anastomosis fistulas in the recipients was resected. The ilecolic artery and vein in the donors were anastomosed to the infrarenal aorta and vena cava of the recipients respectively. The intestinal continuity was restored with an end-to-end anastomosis between the recipients＇ jejunum and the donors＇ ileum, and the distal end was fistulized. Posttransplant immunosuppression was initially administered with FK506, MMF, and prednisone, and the recipients were administered with antibiotic, anticoagulatic drug and subjected to TPN and EN. Results Up to the time this report was submitted the recipient has enjoyed good life quality. The graft small bowel remained functional. The patient was died of an unexpected heart function failure 110 days after operation. Conclusion The living related small bowel transplantation cures the short gut syndrome in this case. Fistulis can be resected safely at the same time. The operative technique and perioperative management is the key of successful transplantation. The posttransplantation immunosuppression is important.