1例小肠移植术后感染的观察与治疗

Monitoring and Treatment of Posttransplant Infection after Intestinal Transplantation with a Case Report

目的:探讨小肠移植后感染的观察和治疗。方法:手术方式采用肠系膜上动脉及肠系膜上静脉分别与受者腹主动脉及下腔静脉行端侧吻合,5-0的prolene缝线连续缝合,供体空肠与受体空肠近端采用端端吻合,供体远端回肠采用外置造瘘。采用巴利昔单抗(舒莱)、兔抗人T细胞免疫球(ATG)、甲基泼尼松龙诱导,术后采用他克莫司(FK506)+麦考酚酯(MPS)+泼尼松三联免疫抑制治疗。结果:术后2周受者出现肺部感染,采用头孢匹罗、伏立康唑、利奈唑胺等抗菌治疗。术后41d,肺部感染控制。结论:有效的灌注以缩短热缺血时间是小肠移植手术成功的基础,合理的使用抗生素和隔离能够有效的控制小肠移植术后感染。

Objective： The observation and treatment of infection in the small intestine transplant will be explored in this article.Method ： The recipient （ a forty-seven-years-old man ） received small intestinal graft following thrombus of arteriae mesenterica superior leading to intestinal resection, and the indication of intestinal transplantation was short-bowel syndrome and repeat catheter-related infection. The anastomosis of the side of the recipient＇s abdominal aorta and donor＇s superior mesenteric artery with continuous 5-0 prolene suture were performed, as well as the side of the recipient＇s abdominal vena cava and donor＇s superior mesenteric vein.Following that, the proximal jejunum of the donor was anastomosed end-to- end to the proximal part of recipient＇s jejunum and the distal end of graft ileum was exteriorized as a stoma.Immuno-induction consisted of basiliximab, thymoglobulin and methyllprednisolone, and then the recipient received tacrolimus, mycophenolate, and corticosteroids to maintain immunosuppression. Result： Pulmonary infection occurred 2 weeks after intestinal transplantation has been controlled gradually by using cefpirome, voriconazo, and linezolid at 41st day postoperation.Conclusion： Sufficient infusion to shorten warm ischemia period play an important role in successfully intestinal transplantation. Posttransplant infection can be controlled with isolation and effectively using antibiotics.