Vascular reconstruction of segmental intestinal grafts using autologous internal iliac vessels

节段性小肠移植手术中采用自体髂内血管进行血管重建

Background The aim of this study was to assess whether the autologous internal iliac artery and vein could be used as an interpositional graft for vascular reconstruction in segmental intestinal allografts and autografts.Methods Thirty-four intestinal transplants(19 living-related allografts and 15 autografts)were conducted in our programs between January 2011 and January 2019.Patient characteristics,type of vascular reconstruction,and post-operative complications were reviewed.Results There were 20 males and 14 females with a median age of 35 years.Of 34 grafts,22(64.7%)(11 allografts and 11 autografts)were revascularized using the autologous internal iliac artery and vein for reconstruction.Vascular reconstruction on the back table took 2166min to complete.Both total operative time and cold ischemia time tended to be longer in the vascular-reconstruction group than in the direct-anastomosis group(5306226 vs 4406116 and 159649 vs 125666 min,respectively),but these differences were not significant.The incidence of vascular thrombosis tended to be higher in the direct-anastomosis group than in the vascular-reconstruction group(16.7%vs 0%,P=0.118).At a median follow-up of 36.9 months,no stenosis or pseudoaneurysms developed.In 19 allografts,acute rejection occurred in 4(21.1%)and chronic rejection occurred in 1(5.2%).Conclusions Our results indicate that the use of an autologous internal iliac interposition graft greatly facilitates intestinal graft implantation and minimizes the risk of vascular complications.

背景:本研究旨在评估自体髂内动静脉可否用于异体及自体节段性小肠移植手术的血管重建。方法:2011年1月至2019年1月间34例小肠移植患者纳入研究,其中19例为亲属活体移植,15例为自体移植。收集患者临床资料、血管重建类型及术后并发症进行分析。结果:全组男性20例,女性14例,中位年龄35岁。在34例小肠移植中,22例(64.7%,其中异体移植和自体移植各11例)采用自体髂内动脉脉进行血管重建,12例(35.3%)直接行血管吻合。血管重建耗时(21˘6)min。与直接吻合组相比,血管重建组患者手术总时长(530˘226 vs 440˘116 min,P=0.208)和冷缺血时间(159˘49 vs 125˘66 min,P=0.097)均有延长的趋势,但差异并未达到统计学意义。直接吻合组术后血栓形成发生率较血管重建组有增高的趋势(16.7%vs 0%,P=0.118)。中位随访36.9个月,无一例出现静脉狭窄或假性动脉瘤。19例异体移植患者中,4例(21.1%)发生急性排斥反应,1例(5.2%)出现慢性排斥反应。结论:本组数据显示,采用自体髂内动静脉进行血管重建可有力促进小肠移植的开展,同时有望降低术后血管并发症的风险。