CAJ | 학술논문

目的总结1例ABO血型不合亲属活体小肠移植的治疗经验.方法患者为女性,16岁,ABO血型为B型,因全部小肠和右半结肠坏死行肠切除、十二指肠残端关闭、胃造瘘术.供者为患者父亲,48岁,血型为AB型.患者术前应用血浆置换、利妥昔单抗与静脉注射人免疫球蛋白的联合方案去除抗B血型抗体.术中移植供者远端回肠180 cm.术后主要以他克莫司及皮质激素为主进行免疫抑制治疗.结果受者术后15 d发生1次轻度急性排斥反应,经激素冲击及抗胸腺细胞免疫球蛋白治疗,成功逆转.由于受者胃排空障碍,术后45 d开始进流质饮食,60 d后经口进食耐受良好,后完全脱离肠外营养.随访12个月,移植肠功能良好,体质量较术前增加4 kg.供者术后6d出院,恢复良好.结论当无ABO血型相同或相容的供者时,可以考虑行血型不合的小肠移植,但应注意选择合适的受者,采取安全有效的免疫抑制方案.
목적 총결1례ABO혈형불합친속활체소장이식적치료경험.방법 환자위녀성,16세,ABO혈형위B형,인전부소장화우반결장배사행장절제、십이지장잔단관폐、위조루술.공자위환자부친,48세,혈형위AB형.환자술전응용혈장치환、리타석단항여정맥주사인면역구단백적연합방안거제항B혈형항체.술중이식공자원단회장180 cm.술후주요이타극막사급피질격소위주진행면역억제치료.결과 수자술후15 d발생1차경도급성배척반응,경격소충격급항흉선세포면역구단백치료,성공역전.유우수자위배공장애,술후45 d개시진류질음식,60 d후경구진식내수량호,후완전탈리장외영양.수방12개월,이식장공능량호,체질량교술전증가4 kg.공자술후6d출원,회복량호.결론 당무ABO혈형상동혹상용적공자시,가이고필행혈형불합적소장이식,단응주의선택합괄적수자,채취안전유효적면역억제방안.
Objective To summarize the therapeutic experience of one case of an ABO incompatible living-related intestinal transplantation with an 18-month follow-up.Method A 16-yearold girl was referred with suspected bowel infarction secondary to superior mesenteric thrombosis.Exploratory laparotomy revealed an extensive bowel necrosis,requiring removal of the third and fourth part of the duodenum,the entire small bowel and the ascending and the proximal transverse colon.The duodenum was closed just distal to the ampulla of Vater and a gastrostomy tube was placed for drainage.After discussion with her family,we decided to undertake a living-related intestinal transplantation.Lab tests indicated her B blood-type but absence of ABO identical or compatible donors in her family.During a long waiting period for a cadaveric donor,she developed several episodes of recurrent aspiration and the lung cavitation.Her 48-year-old father with an AB blood-type was considered as donor.Induction therapy included Rituximab,antithymocyte globulin(ATG) and plasma exchange.The donor's distal 180 cm ileum was transplanted.Result The recipient's postoperative course was remarkable for one episode of mild acute rejection on postoperative day 15,which was successfully treated with steroid bolus and ATG.Due to delayed gastric empty,a clear liquid diet was started on day 45 and she well tolerated a soft diet by day 60 and then was completely off total parenteral nutrition.During an 12-month follow-up period,she gained 4 kg.The donor spent 6 days in hospital and has done well since discharge.Conclusion Our preliminary experience suggests that ABO incompatible living donor bowel transplantation can be lifesaving when ABO identical or compatible donor is unavailable.