临床活体部分小肠移植过程中矛盾现象及处理

The Contradictional Phenomenons and Management in the Process of Clinical Living Related Small Bowel Transplantation

从 1999年至今 ,在国内我们率先成功地施行两例临床活体部分小肠移植术。在整个处置过程中出现许多的矛盾现象。如术前为纠正患者严重的营养不良 ,必须给予肠外营养支持。但是 ,长期的肠外营养又引起患者肝功能损害 ,使患者无法耐受手术 ;对受体来讲 ,当然是移植的肠管越长越有利 ,但是在活体移植的情况下供体只能有限地提供肠管 ,且肠管过长受体也无法接受 ;手术后患者必须应用有效的免疫抑制剂来防治免疫排斥反应 ,而机体在免疫抑制下极易发生感染 ,应用强效而广谱的抗菌素虽然可防治细菌的感染 ,但是可引起菌群的失调导致真菌感染 ;为防止血管内血栓的形成 ,需应用有效的抗凝剂 ,但同时可导致出血倾向等等。我们体会 :正确地处理这些矛盾现象是我们成功的关键。首先要抓重点、抓主要矛盾 ,同时应对可能出现的问题有所感知并给与预防 。

Clinical living related small bowel transplantation has been performed on two patients with short-gut syndromes in our hospital since 1999.There were many contradictional phenomenons during operative period.For example:1.To correct the severe malnutrition,the patients must be given total parenteral nutrition (TPN),but long period TPN could damage the liver function;2.The longer the intestinal graft was,the better nutrition could be obtained for the recipients ,but the donor was not allowed to afford such a long small intestine in living related small bowel transplantation;3.The administration of immunosuppressive drugs to prevent acute rejection would increase the tendency of infection (virus,and bacteria);4.To prevent the formation of thrombosis,antithrombosis (heparin) must be used,but on the other hand,antithrombosis would cause intestinal hemorrhage,etc.Paying more attention to the principal aspect of a contradiction and handle it properly is very important in the process of successful clinical living related small bowel transplantation.