血缘性活体部分小肠移植术二例

Living-related small bowel transplantation: report of 2 cases

目的 探讨血缘性活体小肠移植治疗短肠综合征的效果。 方法 对 2例短肠综合征患者切取有血缘关系的供肠行部分小肠移植术。 1例 18岁 ,男性 ,供体为患者的父亲 ,供肠 15 0cm。另 1例 15岁 ,男性 ,供体为患者的母亲 ,供肠 16 0cm。移植肠动、静脉分别与受者的腹主动脉及下腔静脉行端侧吻合 ,移植肠一期消化道重建 ,末端造口。术后给予抗排异、抗感染、抗凝血及营养支持等治疗。 结果 第 1例患者术后曾出现贫血、急性排异反应 ,经积极处理得到控制 ,目前已存活 2 6个月 ,肠道吸收功能正常 ,自由经口进食 ,能参加日常工作。第 2例患者术后 2 6d发生排异反应 ,经冲击治疗好转 ,术后 80d再次发生重度排异反应 ,经甲基强的松龙冲击无效 ,改为单克隆抗淋巴细胞抗体、抗胸腺细胞球蛋白冲击治疗 ,排异反应虽有好转 ,但发生不可控制的感染 ,抢救无效死亡 ,生存 5个月。 结论 具有血缘关系的活体部分小肠移植是治疗短肠综合征的一种方法。

Objective To investigate the re s ult in treating short bowel syndrome with living-related small bowel transplan tation. Methods Two patients with short bowel syndrome underwent living-related small bowel transplantation. One patient was an 18-year-old boy and the donor was his father. A segment of 150 cm dista l small bowel was resected as the graft from the donor. Another pat ient was a 15-year-old boy and the donor was his mother. The graft was 160 cm long, with arteries and veins anastomosed to the recipient′s infrarenal aorta a nd cava respectively. Intestinal continuity was restored with an end-to-end an astomosis between the recipient′s jejunum and the donor′s ileum, and the dista l end was made as fistulization. Treatment of immunosuppression, antibiotics, a ntithrombosis and nutritional support were given posttransplantation. Results Complications such as anaemia and acute rejecti on occurred in the first recipient and were handled properly and brought under c ontrol after operation. The patient has been surviving 26 months since the trans plantation. The graft′s function is well. The patient can eat food and resume h is daily work. In the second recipient, acute rejection occurred on day 26 after operation and was controlled by implosion therapy. Serious rejection occurred o n day 80 again and did not respond to implosion therapy with methylprednisolone. After use of OKT3 and ATG the rejection was minimized. Because of uncontroll ed infection, the patient died on 5th month after operation. Conclusion Living-related small bowel transplantation is an ideal treatment for short bowel syndrome.