摘要
目的 探讨异体手移植供手的切取和保存方法。方法 所用器材有无菌手术器械、UW液、保温箱、冰块及冰袋、无菌敷料、标签、无菌试管等。在供者被宣布脑死亡后,即行肢体碘伏消毒,从肘关节平面以上5cm作环形皮肤切口,游离肱动脉后插管,用4℃UW液灌注(保留灌洗),再行前臂离断,灌洗至回流液清亮后拔管,肢体作标记后无菌敷料包裹、塑料袋封装,装入放置冰袋的保温箱中快速运输。同时取颈动脉血留作检验用。结果 获取异体手的热缺血时间分别为5分钟、6分钟。至异体手移植术动脉吻合后放血,2例异体手缺血时间分别为6小时、6小时19分。术后生命体征平稳,一般情况好,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8月移植手功能评价:病例1、2手指运动功能恢复等级均为良;病例1,正中神经恢复等级为优,尺神经恢复等级为良;病例2,正中神经恢复等级为可,尺神经恢复等级为可。结论 本组两例异体手移植患者术后病程及功能康复情况证明,异体手的获取和保存是成功的。
Objective To study methods of obtaining and preservation of the donor arm in 2 cases of human hand allograft. Methods After the donor was brain dead confirmed by the physicians, the whole donor arm was strapped with aseptic towels. Around incision 5cm above the elbow was applied and the brachial artery was freed, by which UW solution at 4℃ was infused. After the hand was pale and cool the donor arm was amputated 5cm above the elbow. The donor arm was wrapped in aseptic covering and put into a plastic bag. The bag was immersed into ice water and transported rapidly. Results The time from brain death to amputation of arm was 5 and 6 minutes respectively, and from amputation to releasing of clamp on radial artery was 6h and 6h 19 min respectively. At 8 months both of the two allografted hands were graded good by total active motion evaluation, and in case 1 the median and ulnar nerve recovered excellently and well respectively, and in case 2 both of the median and ulnar nerve recovered fairly. Conclusion The obtaining and preservation of the donor arm was successful in present 2 cases of human hand allograft according to post operation outcomes.
