自体小肠移植在累及肠系膜血管根部疾病手术治疗中的应用

Small bowel autotransplantation after resection of lesions involving the roots of mesenteric vessels

目的:总结西京医院13例自体小肠移植的临床经验,为累及肠系膜血管根部病变的手术治疗提供参考。方法:回顾性分析西京医院13例自体小肠移植患者的临床资料,总结病因、手术情况及并发症,并进行定期随访。结果:13例自体小肠移植手术均成功完成,其中12例病因为肿瘤累及肠系膜根部,肿瘤得到根治性切除,且避免了广泛小肠切除。11例同时联合了根治性胰十二指肠切除术。术后并发症发生率为85%(11/13),其中1例于术后第1天因移植肠血管血栓,移植肠坏死被切除,导致短肠综合征。术后1年存活率69%(9/13),4例死亡患者中2例分别因肝转移和肝、肺转移死亡。术后存活2年以上的5例,均为良性或低度恶性疾病。结论:自体小肠移植适用于以往认为“不可切除”的累及肠系膜血管根部病变的治疗。

Objective To summarize our experience in 13 cases of intestinal autotransplantation(IATx)after resection of lesions involving the roots of mesenteric vessels.Methods The clinical data of 13 patients undergoing IATx in Xijing hospital were retrospectively analyzed.The etiology,surgical procedure and complications were analyzed.The patients were followed up by telephone and regular evaluations.Results All 13 cases of IATx were successfully completed.For 12 patients who were diagnosed with tumors involving the mesenteric roots,the tumors were removed for cure intent avoiding massive intestinal resection.Pancreaticoduodenectomy was carried out simultaneously in 11 cases.The postoperative complication rate was 85%(11/13).The autograft was resected in 1 patient on the 1st postoperative day due to necrosis from mesenteric thrombosis,leading to short bowel syndrome.One-year survival was 69%(9/13).Among 4 deaths,1 patient died of liver metastasis,and another died of liver and lung metastases.Five patients were alive 2 years postoperatively.Conclusion IATx while-technically challenging,avoiding short small bowel syndrome in properly selected patients after resection of lesions especially benign ones involving the roots of mesenteric vessels that were traditionally considered to be"unresectable".