异体手移植的神经再生问题探讨

Nerve regeneration in human hand allotransplantation.

目的 探讨异体手移植免疫抑制状态下的神经再生特点。方法 2例右手缺失病人行异体手移植,手术过程基本同自体断腕再植,术中吻合正中神经、尺神经、尺神经腕背支和桡神经浅支。术后联合应用普乐可复(FK506)等免疫抑制剂抗免疫排斥反应。结果 术后2例病人移植手存活良好,无免疫排斥反应发生。术后1月Tinel征示神经生长超过50mm,2月超过100mm,3月达20cm左右,神经再生速度均超过2mm/d。4月拇、示和小指末节皮肤已恢复痛、温觉;5月始先后出现拇指外展对掌、小指外展等。现术后8个月,手握持功能及手部感觉已恢复,手内在肌功能部分恢复。结论 异体手移植免疫抑制状态下神经再生迅速,在较短时间内恢复手部感觉与手内在肌神经再支配,快于同平面的自体断肢再植,值得进一步探讨。

Objective To explore nerve regeneration under immunosuppression in human hand allotrans-plantation. Methods Hand allotransplantations were performed in two recipients with right hand defect. The operation process was similar to replantation of severed hand at wrist level. Transplantation involved sutures of median nerve, ulnar nerve and its dorsal cutaneous branch, and superficial branch of radial nerve. Combinated immuno-suppressive therapy including tacrolimus(prograf, FK506) was used to suppress rejection. Results Transplanted hands survived well in two cases without immunorejection. Tinel's sign showed that the nerve regenerates more than 50mm in 1 month, more than 100mm in 2 months, and about 20 cm in 3 months after operation, namely more than 2mm per day. Pain and temperature senses recovered to distal segment of thumb and little fingers in 4 months, and abduction of them appeared in 5 months. Now is 12 months after operation, prehension function and sense have almost completely recovered and intrinsic muscles restored partly in hand. Conclusion Nerve regeneration was faster in hand allotransplantation under immunosuppression. Hand sense could recover and intrinsic muscles were rein-erverated in a short term, faster than those in autogenous limb replantation at the same level.