同种异体双手移植一例报告

One case report of double hand allograft

目的探讨同种异体双手移植重建肢体功能的可行性。方法根据ABO血型、Rh血型、人类白细胞抗原(HLA)配型、群体反应性抗体(PRA)检测及淋巴细胞毒性交叉试验等,选择脑死亡者作供体,移植的双手均在腕上5cm处。移植的具体操作基本与自体断肢再植相同。术前两天及术中、术后均联合应用免疫抑制剂。术后观察、排斥反应现象的发生和生命体征及移植的肢体血液循环。结果术后经过顺利,未发生排斥反应现象。移植双手血液循环正常,生命体征平稳。术后10周时尺、桡骨接骨处骨痂生长明显。术后5个月时手部的温痛觉完全恢复。术后7个月时取出尺、桡骨的内固定物同时行肌腱粘连松解术。现患者可完成洗脸、穿衣、叠被褥、持牙刷刷牙、拿勺吃饭、剥橘子、打电话、使用遥控器看电视,缓慢地系鞋带等日常生活动作。结论在联合应用免疫抑制剂的情况下,同种异体双手移植可以存活,而骨愈合和神经生长速度快于自体再植。

Objective To evalute the feasibility of a double hand allogroft to reconstuct the limbs'function. Methods A brain dead donor was chosen under the test of blood group in ABO and Rh,HLA match,PRA and the mixed leukocyte culture.The level of the transplantated hands was 5 cm proximal to the wrists The procedure of the allotransplantation was similar to that of the autologous replantation.The immunosuppressants were taken two days before the operation,in the operation and after the operation. The circulation,the vital signs and the rejection were under the supervision. Results The progress was satisfactory. No rejection was found postoperation.After 10 weeks the callus in both ends of radius and ulna was obvious.After 5 months sensation recovered.After 7 months the internal fixation(plates and screws) was removed and tenolysis was done. Now the recipient could use engrafted hands to wash face,make the bed,wear clothes,brush teeth,peel oranges,eat with a spoon,tie the shoelace slowly,pick up a telephoneor and use the conroller of Television. Conclusions With the immunosuppressive agents,the double hands allograft can survive.The growth rate of bone and nerve is faster than that of autologous replantation.