异体手移植供手的获取和保存

Obtaining and preservation of the donor hands in human hand allotransplantation

目的 通过 2例异体手移植探讨获取和保存供手的方法。方法 在供者被宣布脑死亡后 ,将拟取肢体用 3 %碘酒、75 %酒精常规消毒 ,从肘关节以上 5cm平面作环形皮肤切口 ,游离肱动脉后插管 ,用 4℃UW液灌注 (保留插管 )后行前臂离断 (肱动脉相连 ) ,再灌洗至回流液清亮后拔管 ,肢体作标记后用无菌敷料包裹、塑料袋封装 ,装入放置冰袋的保温箱中快速运输。同时取供者的颈动脉血留作检验用。移植手术基本同自体手再植术。结果 供手的热缺血时间为 5min和 6min。异体手移植的缺血时间为 6h和 6h 19min。术后生命体征平稳 ,移植手血循环良好。免疫学指标检测及术后组织活检证实均无排斥反应发生。术后 10个月 ,例 1、2的手指运动功能恢复达良级 ;例 1正中神经的恢复等级为优 ,尺神经恢复等级为良 ;例 2 ,正中神经恢复等级为可 ,尺神经恢复等级为可。结论 2例异体手移植患者术后功能恢复较为满意 ,异体手的获取是成功的。

Objective To discuss the methods of obtaining and preservation of the donor hands in human allotransplantation. Methods After brain death of the donor was confirmed, the whole donor arm was sterilized with 3 % iodine tincture and 75 % ethyl alcohol and strapped with sterile towels. A circular incision 5 cm above the elbow was made, and the brachial artery was dissected and catheterized for perfusion of UW solution at 4℃. The arm was amputated with the brachial artery still in continuity and catheterized. When the fluid refluxed from the veins was clear, the artery was divided. The marked donor arm was wrapped in aseptic dressing and sealed in a plastic bag. The bag was immersed in ice water and transported rapidly. Carotid artery blood of the donor was taken for examination. Results The time from brain death to amputation of the donor arm was 5 minutes and 6 minutes respectively. The time from amputation to reperfusion of the hand allotransplant was 6 hours and 6 hours and 19 minutes respectively. Postoperatively, the vital signs were normal and blood circulation of the transplants was excellent. Immunological and histological examination indicated no occurrence of rejection. Ten months after the operation, motor function of the fingers in both cases was graded good by total active motion evaluation. In case 1, the function of the median and ulnar nerve recovered to excellent and good respectively, while in case 2 both recovered to fair. Conclusions The obtaining and preservation of the donor arm was successful in the present 2 cases of human hand allotransplantation according to the satisfactory postoperative outcome.