中华器官移植杂志
中華器官移植雜誌
중화기관이식잡지
Chinese Journal of Organ Transplantation
2015年
7期
389-393
,共5页
魏来%陈栋%杜敦峰%曹志新%明长生%陈知水
魏來%陳棟%杜敦峰%曹誌新%明長生%陳知水
위래%진동%두돈봉%조지신%명장생%진지수
肝移植%肠移植%短肠综合征%移植物排斥
肝移植%腸移植%短腸綜閤徵%移植物排斥
간이식%장이식%단장종합정%이식물배척
Liver transplantation%Intestine transplantation%Short bowel syndrome%Graft rejection
目的 探讨肝小肠联合移植的外科技术改进和免疫抑制方案调整对受者预后的影响.方法 回顾性分析1例肝小肠联合移植受者的术中和术后随访资料.在移植手术中未行供者肠管和受者肠管的吻合,将供者肠管近、远端双造口于腹壁,术后8个月再行肠道吻合并闭合肠造口.结果 受者术后肝脏和小肠功能顺利恢复,在术后1个月出现轻微排斥反应导致肝功能受损,未出现肠道功能障碍.术后出现腹腔感染,经手术引流后治愈.受者使用阿仑单抗诱导治疗以及单用他克莫司预防排斥反应,术后2年因肾功能不良改为他克莫司联合吗替麦考酚酯治疗.门诊随访3年余,未出现排斥反应和感染,饮食、排便正常,体质量增加,生活质量良好.结论 通过改进肠道重建方式,以及使用个体化免疫抑制方案,可改善肝肠联合移植患者生存质量,并延长存活时间.
目的 探討肝小腸聯閤移植的外科技術改進和免疫抑製方案調整對受者預後的影響.方法 迴顧性分析1例肝小腸聯閤移植受者的術中和術後隨訪資料.在移植手術中未行供者腸管和受者腸管的吻閤,將供者腸管近、遠耑雙造口于腹壁,術後8箇月再行腸道吻閤併閉閤腸造口.結果 受者術後肝髒和小腸功能順利恢複,在術後1箇月齣現輕微排斥反應導緻肝功能受損,未齣現腸道功能障礙.術後齣現腹腔感染,經手術引流後治愈.受者使用阿崙單抗誘導治療以及單用他剋莫司預防排斥反應,術後2年因腎功能不良改為他剋莫司聯閤嗎替麥攷酚酯治療.門診隨訪3年餘,未齣現排斥反應和感染,飲食、排便正常,體質量增加,生活質量良好.結論 通過改進腸道重建方式,以及使用箇體化免疫抑製方案,可改善肝腸聯閤移植患者生存質量,併延長存活時間.
목적 탐토간소장연합이식적외과기술개진화면역억제방안조정대수자예후적영향.방법 회고성분석1례간소장연합이식수자적술중화술후수방자료.재이식수술중미행공자장관화수자장관적문합,장공자장관근、원단쌍조구우복벽,술후8개월재행장도문합병폐합장조구.결과 수자술후간장화소장공능순리회복,재술후1개월출현경미배척반응도치간공능수손,미출현장도공능장애.술후출현복강감염,경수술인류후치유.수자사용아륜단항유도치료이급단용타극막사예방배척반응,술후2년인신공능불량개위타극막사연합마체맥고분지치료.문진수방3년여,미출현배척반응화감염,음식、배편정상,체질량증가,생활질량량호.결론 통과개진장도중건방식,이급사용개체화면역억제방안,가개선간장연합이식환자생존질량,병연장존활시간.
Objective To discuss the improvement of surgical techniques and adjustment of immunosuppressive regimen for combined liver and intestinal transplantation.Method A male patient with liver dysfunction and short bowel syndrome underwent the combined liver and intestinal transplantation.Ostomy of graft was performed instead of intestinal anastomosis during the operation.The anastomosis of graft and autologous intestine was performed 8 months after transplantation.Hospital and follow-up data of the patients were analyzed retrospectively.Result The functions of liver and small bowel recovered smoothly after operation.Slight rejection occurred one month after operation with normal function of intestine but dysfunction of liver.In the first month after operation, abdominal infection was controlled by intraperitoneal drainage with open surgery.Immunosuppression protocol was administrated with alemtuzumab for induction plus maintenance treatment with tacrolimus, and mycophenolate mofetil was added because of renal dysfunction 2 years after transplantation.The patient was followed up for nearly 3 years with good quality of life without rejection and infection.Conclusion Combined liver and intestinal transplantation could improve patient's life quality and extend the survival time through the improvement of surgical techniques and individual immunosuppressive regimen.
