亲体小肠移植中供肠的获取与修整

Techniques of procurement and back-table surgery of graft in living-related small bowel transplantation

目的探讨亲体小肠移植中供者小肠的获取和修整技术。方法根据亲体小肠移植供者的标准在父母中筛选合适供者,设计手术方案。选择回肠作为移植肠袢,采用保留回盲瓣及远端20 cm回肠留存供者,获取回肠120 cm及肠系膜作为移植肠袢,总结手术中测量肠管长度方法;综合采用透光、触摸搏动判断肠系膜上动脉分支,暂时阻断血流判断供肠和残留肠管血运的方法;总结获取移植肠管中供者血管的选择和处理方法。结果供、受者手术顺利,移植肠袢功能良好。供者除短期轻度腹泻外,无肠系膜血栓和吻合口瘘等并发症。供者术后14 d完全康复出院,随访8个月,无排便习惯改变;体重维持术前水平。结论选择回肠作为移植肠袢,保留同盲瓣及远端20 cm回肠的获取技术难度较小,供者术后近期和远期风险较小,而受者可取得良好效果。

Objective To analyze the surgical techniques of procurement and back-table sur- gery of graft in living-related small bowel transplantation.Methods Eligible donors were chosen ac- cording to the donor selection criteria of living-related small bowel transplantation.A 120 cm segment of ileum was procured.Other 20 cm segment from proximal to ileocecal valve (ICV) was preserved in the donor.Techniques of procurement and back-table surgery of the graft involved measurement of entire small bowel length from Treitz to ICV,palpation and transillumination to identify the distal branch of superior mesenteric artery (SMA),and transient blockage of isolated blood vessels with vascular clamps to observe the influence on blood circulation of graft and residual ileum.Detailed manipulation tech- niques in processing the graft blood vessels were discussed.Results The donor's and recipient's opera- tions were successful.The implanted bowel segment functioned well.The donor had no other complica- tions like mesenteric thrombi and anastomosis leakage of intestine,except transient moderate diarrhea. She was discharged from the hospital 14 days after operation.In the next 8 months of follow-up,the donor keeps her weight and good appetite without any change in bowel habit and amount on diet.No changes have been found in her lifestyle,work habits,or psychosocial conditions after the donation. Conclusions The protocol that procuring a segment of ileum as graft and preserving the donor 20 cm proximal to ICV is technically less challenging.Using a standardized technique with attention presents little immediate or long-term risks for the donor and brings the recipient satisfied results.