辅助减体肝、肠联合移植术一例

One case of small bowel transplantation combined with a reduced auxiliary liver graft

目的 研究辅助减体肝、肠联合移植的手术技术和免疫抑制方案。方法 从一成年供者获取整块肝 ,肠 ,脾 ,肾后 ,将减体肝脏和十二指肠 ,空肠 ,部分回肠植入一无小肠的患者体内。术前和术后使用环孢素A(CsA) ,甲泼尼龙 (MP) ,环磷酰胺 (CTX)免疫抑制治疗 ,给予抗凝和肠外营养支持疗法 (TPN)。结果 临床观察和病理检查结果提示移植的肝肠存活良好 ,肝功能指标中除血浆总蛋白和白蛋白低于正常值以外 ,其余指标 (转氨酶 ,总胆红素 ,1min胆红素 ,胆固醇 ,甘油三脂等 )均在正常范围 ,血清肌酐值 80～ 10 0mmol/L ,氮平衡 - 1～ + 1。术后并发肠瘘、应激性溃疡大出血、成人呼吸窘迫综合征 (ARDS)、肺部和腹腔感染 ,最后死于心肺功能衰竭 ,共存活 30d。结论 辅助减体肝、肠联合移植的手术技术是可行的 ,术中和术后采用CsA ,MP ,CTX免疫抑制治疗是有效的 。

Objectives To investigate the surgical procedures and immunosuppressive scheme of small bowel transplantation combined with a reduced auxiliary liver graft. Methods Organ cluster of liver, small bowel, spleen, kidney were harvested from an adult donor. The liver, duodenum, jejunum and partial ileum from the organ cluster were grafted into abdominal cavity of the recipient. Left lateral lobectomy and right frontal lobectomy on donor liver were performed for reducing the volume of the liver. Cyclosporin A (CsA), methylprednisolone (MP) and cytoxin (CTX) were administered preand postoperatively for immunosuppressive therapy. Anticoagulant therapy and total parenteral nutrition were given. Results The grafted liver and small bowel were well survival. ALT, AST, T bil, cholesterol and triglyceride were normal, but except for serum album and total protein. Complications of intestinal fistula, stress ulcer and bleeding, ARDS, pulmonary and abdominal infection occurred after operation. The patient died from heart failure and lung failure and survived 30 days. Conclusions Small bowel transplantation combined with a reduced auxiliary liver is feasible. Immunosuppressive therapy with CsA, MP and CTX is effective. Auxiliary liver transplantation has probable protective effects on simultaneously transplanted small bowel.