CAJ | 학술논문

目的总结1例保持门静脉连续性的小肠双造口方式肝小肠联合移植病例的手术操作和术后处理的经验.方法受者为短肠综合征合并肝功能不良的男性患者,供者为尸体供者.联合切取器官,确保供者肠系膜上静脉和门静脉的连续性.移植肝静脉采用背驼式吻合,受者自体门静脉和供肝门静脉端侧吻合,胆道端端吻合,供者肝动脉和肠系膜上动脉吻合于受者腹主动脉；移植小肠约2 m,两端双造口于腹壁,未作肠道吻合.采用人源化抗CD52单克隆抗体诱导治疗,维持期单用他克莫司.行内镜下黏膜活检监测排斥反应.结果术后1个月内,患者发生腹腔感染和疑似排斥反应各1次,分别经过手术和甲泼尼龙冲击治疗后痊愈.随访6个月,受者移植肝和小肠功能恢复良好,但仍有腹泻,需补充静脉营养,体重尚未完全恢复.结论保持门静脉连续性的小肠双造口方式肝小肠联合移植可以简化手术操作,发生外科并发症的风险小,有利于肝脏和小肠功能恢复及术后排斥反应的监测,但是消化液未能进入移植小肠,也影响了受者的恢复.
목적 총결1례보지문정맥련속성적소장쌍조구방식간소장연합이식병례적수술조작화술후처리적경험.방법 수자위단장종합정합병간공능불량적남성환자,공자위시체공자.연합절취기관,학보공자장계막상정맥화문정맥적련속성.이식간정맥채용배타식문합,수자자체문정맥화공간문정맥단측문합,담도단단문합,공자간동맥화장계막상동맥문합우수자복주동맥；이식소장약2 m,량단쌍조구우복벽,미작장도문합.채용인원화항CD52단극륭항체유도치료,유지기단용타극막사.행내경하점막활검감측배척반응.결과 술후1개월내,환자발생복강감염화의사배척반응각1차,분별경과수술화갑발니룡충격치료후전유.수방6개월,수자이식간화소장공능회복량호,단잉유복사,수보충정맥영양,체중상미완전회복.결론 보지문정맥련속성적소장쌍조구방식간소장연합이식가이간화수술조작,발생외과병발증적풍험소,유리우간장화소장공능회복급술후배척반응적감측,단시소화액미능진입이식소장,야영향료수자적회복.
Objective To discuss the surgical procedures and treatment after combined liver and intestinal transplantation with portal venous drainage and enterostomy of two ends in one case.Methods A male patient with liver dysfunction and short bowel syndrome underwent the combined liver and intestinal transplantation.With the techniques of "en bloc",the liver and intestinal grafts were harvested from cadaveric donor.The intestinal graft,200 cm long,was implanted with portal venous drainage and aortic inflow,and enterostomy of both ends was performed instead of intestinal anastomosis.The liver graft was placed in a piggyback fashion with end to end anastomosis of the bile ducts without T tube. Inmunosuppression protocol was administrated with campath-1H and tacrolimus.Endoscopic biopsy of intestinal graft was performed regularly,and clinical observation was done to monitor the acute rejection.Results In the first month after operation,abdominal infection was controlled by intraperitoneal drainage with open surgery.One suspect acute rejection was treated with methylprednisolone.Until sixth month,the functions of liver and intestine were progressively restored.However,the patient lost weight and could not be free from intravenous nutrition because of diarrhea.Conclusion Combined liver and intestinal transplantation with portal venous drainage and enterostomy of two ends is a simple surgical procedure with lower risk of surgical complications.This method is propitious to monitoring rejection and function improvement of the grafts.Diarrhea and loss of digestive juice are the main reasons of low body weight and malnutrition.