活体小肠移植术后移植肠功能的监测

Graft function following living-related small bowel transplantation

目的 探讨活体小肠移植术后移植肠功能的检测方法。方法 对国内首例活体小肠移植术后患者观察其饮食状况、消化道症状,定期予以血、尿、便常规和肝肾功能及营养指标的检测,并进行免疫抑制剂普乐可复(FK506)全血质量浓度测定,以监测移植肠功能的恢复情况。结果 患者至今健康生存48个月余,并已参加工作。能自由进食,大便成形,1～2次/d,体重维持在56～58 kg,血红蛋白120g/L以上,白浆总蛋白、白蛋白正常。D-木糖吸收试验,尿中排出率在26％～30％。FK506血药浓度维持在5～6ng/ml,吸收功能稳定。全消化道钡餐检查,肠蠕动良好,无狭窄性改变。结论 营养指标、D-木糖吸收试验、FK506全血质量浓度等检测能有效判定移植小肠的功能。

Objective To evaluate the graft function following living-related small bowel transplantation. Method Diet intake, function of digestive tract and nutritional indexes of the first recipient of living-related small bowel transplantation in China were assessed, and the routine items of blood, urine and stool were measured regularly. The function of the liver, kidney and the content of Tacrolimas (FK506) in total blood were also determined. Results The recipient has so far lived for 48 months, enjoying good health with a body weight of 56 - 58 kg and regular diet with 1-2 times shaped bowels per day and working as a janitor. The hemoglobin level was above 120 g/L and total serum contents of protein and albumin were normal. D-xylose absorption test showed that the clearance rate in urine was 26% - 30%. The serum content of FK506 varied between 5-6 ng/ml, indicating a good absorptive function of the graft. The whole digestive duct barium meal showed that the graft peristalsis was normal with no stricture. Conclusion Monitoring nutritional indexes, D-xylose absorption test and Tacrolimas (FK506) content in total blood etc, are effective ways to assess the function of transplanted small bowel.