上腹部器官簇移植手术方式的探讨

目的探讨上腹部器官簇移植治疗多脏器恶性肿瘤的可行性及临床效果。方法上腹部器官簇移植受者2例,其中男、女各1例;均为胰腺癌肝转移患者。2例患者分别于2004年5月和8月接受上腹部器官簇移植治疗,切除脏器包括全胃、肝脏、胰腺、脾脏、十二指肠及部分空肠,移植器官簇包括肝脏、胰腺、十二指肠。其中1例胰腺肿物侵犯肠系膜上动脉（SMA）,切断SMA后,其远端与右髂总动脉吻合重建血供。结果2例患者于术后4h及5h清醒,8h及10h后撤除呼吸机;术后第3天及第5天从外科加强治疗病房转至普通病房。肝功能指标在手术1周后趋于正常;胰腺功能在10d内达到正常范围。1例患者存活12个月,死于肿瘤复发;另1例术后恢复平稳,术后20d自动出院。结论肝胰十二指肠器官簇移植为上腹部局部多脏器恶性肿瘤提供了一种手术上可行并具有一定疗效的治疗方法。

Study of surgical procedures of abdominal organ cluster transplantation

Objective To evaluate the surgical procedures and therapeutic effect of organ cluster transplantation in treating abdominal multiple organ malignances. Methods Two patients with abdominal multiple organ malignances received organ cluster transplantation in May and August 2004. The excised specimen included liver, pancreas, duodenum, stomach, spleen, mesenteric and epigastric lymph nodes. The transplanted organs included liver, pancreas, duodenum. Superior mesenteric artery was involved in the malignancy in one case and was transected and anastomosed to right common iliac artery. Results The patients waked up 4 and 5 hours post operation and began recovering 3 and 5 days after. Dynamic examinations showed that the functions of grafted liver, pancreas and duodenum obtained normal function in 10 days pest the transplantation. One patient survived for 12 months postoperatively and died of recurrence of cancer; The other recovered uneventfully after transplantation, and discharged automatically 20 days after. Conclusions Abdominal organ cluster transplantation is technically feasible and effective for patients with abdominal multiple organ malignances.