同种异体非整块肝脏-小肠联合移植

Non-composite combined liver and intestinal allotransplantation

目的 报告国内首例同种异体非整块肝肠联合移植 ,重点讨论外科技术 ,并与整块肝肠联合移植技术进行比较。方法 患者因短肠综合征和全肠外营养 (TPN)肝病接受非整块肝肠联合移植 ,植入小肠 3 80cm。肠系膜上动脉、门静脉分别与受体腹主动脉、下腔静脉端侧吻合 ;供肝行改良背驮式肝移植。供体热缺血时间为 2min 3 0s ,移植肠冷缺血 6h 40min ,移植肝冷缺血 8h 7min。术后免疫抑制方案采用FK50 6+激素 +骁悉 +赛尼哌。结果 患者恢复顺利 ,未发生排斥反应 ,至今仍存活 ,已恢复完全肠道营养。结论 非整块肝肠联合移植技术适合于成年受体 。

Objective To report the first case of non-composite co mbined liver and intestinal allotransplantation in China. The technical aspects of the case and pros and cons of such an approach versus composite technique were discussed. Methods The patient suffered from short bowel syndrome and TPN-related liver damage. A non-composite technique was used in this case. During operation, the whole 380 cm intestine was transplanted with systemic drainage and aortic inflow, while the liver graft was placed in a piggyback fashion. Warm ischemic time of donor graft was 2 min and 30 saconds, and cold ischemic duration for intestinal and liver graft was 6 hours and 40 and 8 hours and 7 utes respectively. Postoperative immunosuppression management includes tacrolimus, methylprednisolone, MMF and Zenapax. Results The recipient recovered smoothly with no evidence of rejection on days′ follow up. Now he is maintained well on enteral nutrition. Conclusion Non-composite technique should be considered in adult recipients, especially those with a history of abdominal infections or multiple laparotomies.