同种异体手、拇指移植临床报告

A clinical report of human hand and thumb allograft

目的探讨同种异体手、拇指移植的可行性。方法同时选择两名ABO、Rh血型相同,不同侧手、拇指缺失的患者作为移植对象(左手、右拇指),与同一供体配型,确定合适供体。供体双上肢在无菌条件下经肘关节离断,4℃肝素生理盐水经肘部动脉灌注,低温保存。移植手术包括吻合动、静脉、神经、屈伸肌腱,克氏针贯穿内固定。术中优先吻合桡动脉,静脉端放血,利用受体自身血再次灌注移植手、拇指。术后常规“三抗”治疗、抗排斥反应治疗和功能锻炼。结果移植手、拇指术后经过顺利,未发生明显排斥反应。术后2周移植拇指虎口背侧发生感染,经调整抗生素,局部换药,再次缝合伤口,第5周拆线愈合。术后15个月,移植手、拇指血循环、皮肤温度、颜色与正常对侧相同。移植左手、右拇指感觉恢复到指尖,而且可以持物,功能恢复满意。结论严格术前准备、合理术后用药(联合应用新型、高效抗免疫排斥药物)和及时功能锻炼,异体手、拇指移植是可行的,而且近期疗效和功能满意。

Objective To explore the feasibility of human hand and thumb allograft. Methods Two male recipients, one with traumatic left hand defect and another with traumatic right thumb defect, were matched respectively with a donor died of cerebral injury on ABO and Rh blood type. The suitable compatibility on ABO and Rh blood type was confirmed. Both upper extremities of the donor along elbow joint level were amputated and irrigated with heparin saline at 4℃via brachial artery thoroughly. Then put them into an ice box. The transplantation procedure was similar to that of autologous replantation of amputated hand and thumb. As an important step, the radial artery was anastomosed at first and then the blood was poured out from the vein end. The allografts were irrigated with the ceptors blood respectively. After surgery the patients were given wide spectrum antibiotics, anticoagulation, antispasm agents, and the immunosuppressants. Results The postoperative recovery of allografts was successful. The stitches of wound were taken out 4 after the operation. After 2 weeks local superficial soft tissue infection occurred at the back of the transplanted thumb, then the infection was soon controlled and healed fully by the adjusted therapy scheme. 15 monthes after the surgery, the circulation, the skin temperature and color of the transplanted hand, and thumb were similar to those on the normal side. The transplanted left hand and right thumb can hold things and the esthesia could get to the end of fingers. Conclusions Human hand, and thumb allograft was feasible with strict preoperative preparation and reasonable postoperative medications. The early effects and functional recovery were satisfactory according this papers data.