全内脏反位尸体供肝原位肝移植(附1例报告)

Orthotopic Homotransplantation of Liver with Whole Reversed Viscera Cadaveric Donor(One Case Report)

本文报告罕见的全内脏反位尸体供肝原位肝移植1例。受者系不能切除的高位胆管癌胆管引流术后病人。该例成功地应用改良Starzl法腹腔多脏器联合切取供肝肾给二病人;无肝期使用国产人工心肺机单泵行下腔、门静脉—上腔静脉外转流以稳定血循环动力学;应用供者髂内动脉架桥以解决反位肝动脉距离加大的矛盾;并用动脉血酮体比监测供肝活力。但术后12日死于绿脓杆菌败血症。

A case of orthotopic liver homotransplantation was Performed on may 21st,1990 for the treatment of hepatic hilar chlangioadenocarcime,which invaded common hepatic duct and both right and left hepatic ducts and could not be removed.Seven months be- fore the transplantation outer drainage procedure with U tube in the right hepatic duct and T tube in the left was done.During the cadaveric harvesting the whole viscera were found in reverse position,so that the warm ischemia time extended to ten minutes and twenty seconds.Cold ischemia time was six hours and 35 minutes.The operation took 17 hours and 15 minutes smoothly.After operation the liver function was good,and the draining bile was mucous and dark yellow with the volume increasing day by day until the eighth day when he suffered from pyocyanic septicemia.On the twelveth day after transplantation he died of respiratory and circulatory failures caused by septicemia. The peculiarities of this case were as follows:1.The cadaveric multiple abdominal organs,including liver,pancreas,spleen,duodenum,both kidneys with aorta and infe- rior vena cava were resected en bloc,by modified Starzl's method as quickly as possi- ble Then the liver and left kidney with their vessels were removed respectively with care on a disinfected ice plate.2.During unhepatic stage of the transplant operation,a native artificial cardiac and pulmonary pump was successfully used to transfer one liter of blood per minute from the inferior vena cava and portal vein to the superior vena cava to maintain stable hemodynamics.3.A segment of the internal iliac artery was used as a bridge to compensate the extended distance between donor and recepient hepatic ar- teries.4.The keto body ratio in the arterial blood was a sensitive indicator monitoring the donor liver vitality and acute rejection.