CAJ | 학술논문

目的探讨心脏死亡器官捐赠(DCD)应用于腹部多器官移植的可行性及疗效.方法 2例乙型肝炎肝硬化、肝癌合并2型糖尿病患者接受保留自身胰腺的多器官(肝、胰和十二指肠)移植,供者为符合“中国心脏死亡器官捐献分类标准”中的中国三类(C-Ⅲ类)标准的2例男性捐献者.采取多器官联合切取法完整切取供者的肝脏、胰腺、十二指肠和部分空肠,利用供者的髂外、髂内动脉将供者的腹腔干和肠系膜上动脉成型为一个出口,与受者的腹主动脉行端侧吻合.受者的胰腺不切除,其门静脉与移植物的门静脉后壁行端侧吻合,供者的十二指肠降部与受者的上段空肠行侧侧吻合.结果 2例的丙氨酸转氨酶、天冬氨酸转氨酶及胆红素总量等肝功能指标在术后2周达正常水平；术后7d血糖恢复正常；术后4d血淀粉酶和脂肪酶恢复正常；术后1～2周空腹血C-肽和胰岛素达正常范围.1例术后出现肠吻合口瘘,经穿刺引流,4周后痊愈.2例受者分别在术后8周和5周康复,肝功能及胰腺功能正常,未再使用胰岛素.结论符合C-Ⅲ类DCD供者的器官可用于腹部多器官移植,术后移植物功能良好.
목적 탐토심장사망기관연증(DCD)응용우복부다기관이식적가행성급료효.방법 2례을형간염간경화、간암합병2형당뇨병환자접수보류자신이선적다기관(간、이화십이지장)이식,공자위부합“중국심장사망기관연헌분류표준”중적중국삼류(C-Ⅲ류)표준적2례남성연헌자.채취다기관연합절취법완정절취공자적간장、이선、십이지장화부분공장,이용공자적가외、가내동맥장공자적복강간화장계막상동맥성형위일개출구,여수자적복주동맥행단측문합.수자적이선불절제,기문정맥여이식물적문정맥후벽행단측문합,공자적십이지장강부여수자적상단공장행측측문합.결과 2례적병안산전안매、천동안산전안매급담홍소총량등간공능지표재술후2주체정상수평；술후7d혈당회복정상；술후4d혈정분매화지방매회복정상；술후1～2주공복혈C-태화이도소체정상범위.1례술후출현장문합구루,경천자인류,4주후전유.2례수자분별재술후8주화5주강복,간공능급이선공능정상,미재사용이도소.결론 부합C-Ⅲ류DCD공자적기관가용우복부다기관이식,술후이식물공능량호.
Objective To evaluate the therapeutic effect of abdominal multiple visceral organ transplantation for hepatic cirrhosis combined with diabetes by using donation after cardiac death (DCD).Methods Two patients suffering from hepatitis B-related liver cirrhosis,hepatocellular carcinoma combined with insulin dependent type 2 diabetes mellitus were given multiple visceral organ transplantation from May to June 2012.The transplanted organs including the liver,pancreas and duodenum were obtained from two donors after cardiac death which accorded with C-Ⅲ criteria.The donor internal and external iliac arteries were anastomosed to celiac axis and superior mesenteric artery and then the donor arteria iliaca communis was anastomosed to recipient abdominal aorta.The portal vein reconstruction was performed by end-to-side anastomosis between the donor and recipient portal vein.The pancreatic juice drainage was achieved by side to side anastomosis between donor duodenum and recipient jejunum.The pancreases of recipients were retained.Results The alanine aminotransferase,aspartate aminotransferase and total bilirubin of two patients were recovered to normal level at 2nd week after operation.The blood glucose and serum amylase returned to normal levels at 7th d and 4th d respectively.The fasting serum C-peptide and insulin were also at normal level at 2nd week.One patient with local intestinal anastomotic fistula was given percutaneous puncture drainage for four weeks and recovered.One patient recovered smoothly one month after transplantation without surgical complications.Conclusion Abdominal multiple visceral organ transplantation is an effective treatment for hepatic cirrhosis combined with diabetes by using DCD donor.