临床同种活体部分小肠移植：附1例报告

目的：探讨临床同种活体小肠移植治疗短肠综合征的效果。方法：对1例因小肠扭转而切除大部分小肠和右半结肠，残留小肠仅20cm的超短肠综合征男性患者，行亲属活体同种部分小肠移植。供体为患者之母。受体术前行供体特异性输血，50mL/周，共8周。供受体巨细胞病毒感染状态均为阴性。移植肠长约160cm。移植肠的回结肠动静脉分别与受体肾下腹主动脉和下腔静脉端侧吻合，移植肠末端造口。术后给予抗排斥、抗感染、抗凝及营养支持治疗。结果：供体术后恢复顺利，无并发症。受体已健康存活31周，无感染和排斥反应。术后8周脱离肠外营养治疗，口服低脂饮食，D－木糖吸收试验结果接近正常。结论：同种活体部分小肠移植是治疗短肠综合征的有效措施。     

活体部分小肠移植治疗短肠综合征并肠瘘1例的临床经验

目的 总结活体部分小肠移植在治疗短肠综合征合并肠瘘中的临床经验.方法 1例短肠综合征合并肠瘘患者接受其子的150 cm 回肠,供肠动、静脉分别与受体的腹主动脉和下腔静脉行端侧吻合,受体残余空肠与供体回肠近端行端端吻合,受体结肠与供肠远端行端侧吻合,供肠远端造瘘作为观察窗,术后给予免疫抑制等治疗. 结果患者小肠移植术后恢复顺利,肠道功能恢复,血管吻合口通畅,正常生活110 d后因心脏意外死亡.结论 短肠综合征合并肠瘘患者实施活体部分小肠移植是可行的,植入肠管的血管植入技术对小肠移植成功非常重要.     

临床活体部分小肠移植术的血管处理技术

目的　报告我国首例活体小肠移植术的血管处理技术。方法　为 1例 18岁的男性超短肠综合症患者施行了活体部分小肠移植术 ,供肠来自患者的父亲 ,切取供体回肠 15 0cm ,UW液灌洗血管。将移植肠动、静脉分别与受体腹主动脉及下腔静脉端侧吻合。移植肠近端与受体空肠近端行端端吻合 ,移植肠远端与受体空肠远端行侧端吻合 ,末端造口。术后给予抗排斥 ,抗感染 ,抗凝及营养支持等治疗。结果　术后曾出现贫血 ,单纯疱疹感染和急性排斥反应 ,经积极处理得到控制 ,目前患者健康 ,生存 11月余。结论　活体小肠移植术中处理好供、受体的血管对手术成功至关重要。     

活体部分小肠移植供受体围手术期的处理

目的 报告国内首例活体部分小肠移植的手术经过和围手术期处理。方法 受者为男性直肠癌术后１８岁,因短肠综合征而接受小肠移植。供体,男性,４４岁,为受体之父。取供体回肠末段１５０ｃｍ,移植肠血管与肾上腹主动脉,下腔静脉吻合,移植肠近端与受体残留空肠的端行端端吻合,移植肠无端与受体残留空肠远端行侧端吻合,移植肠末端造口作为观察窗。免疫抑制方案为ＦＫ５０６、骁悉、甲基强的松龙联合用药。结果 受者术后已健康     

亲缘性活体部分小肠移植术

目的 介绍我国首例亲缘性活体部分小肠移植术的临床处理体会。方法 受体为男性,18岁,因短肠综合征而接受小肠移植。供体,男性,44岁,为受体之父。取供体回肠末段150cm,移植给患者,术后给予抗免疫排斥、抗感染、抗凝及营养支持等治疗。结果 目前,患者已健康生存19个月,移植肠功能恢复良好。结论 亲缘性活体部分小肠移植术是治疗短肠综合征的有效手段,良好的术后管理是确保活体小肠移植手术成功的关键。     

亲体小肠移植供肠获取与修整技术

目的探讨亲体小肠移植中供体小肠的获取和修整技术。方法根据亲体小肠移植供体的标准在父母中筛选合适供体,设计手术方案。选择回肠作为移植肠袢,采用保留回盲瓣及远端20cm回肠给供体,获取回肠120cm,总结手术中测量肠管长度的方法;综合采用透光、触摸法判断肠系膜上动脉分支,暂时阻断血流判断供肠和残留肠管血运;总结获取移植肠管中供体血管的选择和处理方法。结果供、受体手术顺利,移植肠袢功能良好。供体除短期轻度腹泻外,无肠系膜血栓、肠瘘等并发症。供体术后14d完全康复出院,随访8个月,无排便习惯改变;体重维持术前水平;食欲良好,无饮食习惯和进食量改变;未出现生活、工作习惯改变或心理改变。结论选择回肠作为移植肠袢,保留回盲瓣及远端20cm回肠给供体是理想的供肠获取方法,标准细致的操作方法对供体造成的近期和远期风险较小,并为获得优良的移植效果奠定基础。     

活体部分小肠移植一例报告

目的 对临床活体部分小肠移植进行总结。方法 为1例患超短肠综合的18岁男必患者施行父亲供肠的活体部分小肠移植术,移植肠段为150cm长之回肠,以UW液灌洗。移植肠动、静脉分别与受者的腹主动脉及下腔静脉端侧吻合,移植肠近端与受者的空肠近端行端端吻合,远端与受者的空肠远端行侧端吻合,末端造口。术后给予抗排斥、抗感染、抗凝及营养支持等治疗。结果 术后曾出现贫血、单纯疱疹病毒感染和 急性排斥反应,经积极处理行到控制目前患者已健康存活14月余。结论 活体部分小肠移植是治疗短肠综合征的一理想方法。     

血缘性活体部分小肠移植术二例

目的 探讨血缘性活性小肠移植治疗短肠综合征的效果。方法 对2例短肠综合征患者切取有血缘关系的供肠行部分小肠移植术,1例18岁,男性,供体为患者的父亲,供肠150cm。另1例15岁,男性供体为患者的母亲,供肠160cm。移植肠动、静脉分别与受者的腹主动脉及下腔静脉行端侧吻合,移植肠一期消化道重建,末端造口,术后给予抗排异、抗感染、抗凝血及营养支持等治疗。结果 第1例患者术后曾出现贫血、急性排异反应,经积极处理得到控制,目前已存活26个月,肠道吸收功能正常,自由经口进食,能参加日常工作,第2例患者术后26d发生排异反应,顷冲击治疗好转,术后80d再次发生重度排异反应,经甲基强的松龙冲击无效,改为单克隆抗淋巴细胞抗体、抗胸腺细胞球蛋白冲击治疗,排异反应虽有好转,但发生不可控制的感染。抢救无效死亡。生存5个月。结论 具有血缘关系的活体部分小肠移植是治疗短肠综合征的一种方法。     

短肠综合征合并高位肠瘘患者施行亲属活体小肠移植一例

目的总结短肠综合征合并高位肠瘘患者施行亲属活体小肠移植的经验和体会。方法为1例因肠系膜上动脉栓塞而切除空肠、大部分回肠及右半结肠的患者施行亲属活体小肠移植,供者为患者之子,移植回肠长度为150 cm,供肠热缺血时间1 min,冷缺血时间65 min。受者切除肠瘘,供肠动、静脉分别与受者的腹主动脉和下腔静脉行端侧吻合,供肠的近端与受者的空肠残端行端端吻合,远端侧壁与结肠残端行侧端吻合,移植小肠末端造口,作为观查窗。术后使用他克莫司、霉酚酸酯和甲泼尼龙预防排斥反应,并给予抗感染、抗凝以及胃肠外为主、肠内营养为辅的支持治疗。结果术后移植小肠功能接近正常,能胜任一般的体力劳动。术后110 d,患者因情绪变化突发心脏意外,抢救无效死亡。结论合并肠瘘的短肠综合征并非小肠移植禁忌证,术前充分准备和术后细致观察及管理是成功的关键。     

母子亲体小肠移植治疗小肠衰竭的方法及疗效探讨：附1例报告

目的：探讨母子亲体小肠移植的方法及其对短肠综合征所致小肠衰竭的疗效。方法：为1名15岁短肠综合征（仅残留小肠8cm）致小肠衰竭的男患者行小肠移植术。供体为患者母亲。取供体带血管蒂回肠中下段1.2m移植于受体腹腔，两端分别造瘘及作人工肛。二期手术于6个月后施行，将受体残余肠中部横断，上下端分别与供肠近、远段行端侧吻合。结果：供、受体手术顺利。受体一期手术后曾发生感染及排斥，经治疗后痊愈。二次术后随访8个月，受体小肠功能逐渐恢复，患者体重明显增加，一般情况好，进食半流质，生活能自理。结论：亲体小肠移植是治疗短肠综合征肠衰竭的有效方法。排斥和感染是威胁小肠移植安全的主要因素。     

Small bowel transplantation using grafts from living‐related donors. Two case reports

Abstract A living‐related small bowel transplantation (SBT) was performed in two pediatric patients with short bowel syndrome. In both cases, the donor was the patient's mother. The distal ileum (100 cm, 120 cm) was harvested and the ileocolic vessels, ileocecal valve, and terminal ileum were left intact. The two donors were discharged from the hospital on postoperative days 15 and 6, respectively. Recipient 1 was a 2 year 6 month‐old boy with short bowel syndrome who underwent SBT due to loss of venous access. The graft vein was anastomosed to the recipient's infrarenal inferior vena cava. Despite triple immunosuppression (tacrolimus, steroid, and azathioprine), there were four episodes of rejection. The patient had been on total parenteral nutrition for almost his entire post‐transplant course. He died from Pneumocystis carinii pneumonia 16 months after the transplantation. Recipient 2 was a 4 year 5 month‐old girl with short bowel syndrome who underwent an isolated small bowel transplantation because of recurrent line sepsis. Her pretransplant bilirubin was 8.0 mg/dl and a biopsy showed severe fibrosis. The graft vein was anastomosed to the recipient's inferior mesenteric vein. After transplantation, her bilirubin level became normal within 10 days. Triple immunosuppression (tacrolimus, steroid, and cyclophosphamide) together with a 3‐day course of OKT‐3 made her post‐transplant course feasible. After overcoming a single episode of rejection she left the hospital 4 months after SBT. The patient is currently (10 months after transplantation) hospitalized due to rejection, which is being successfully controlled, and she is off total parenteral nutrition. From our experience, harvesting of the distal ileum for use as a bowel graft can be safely performed. The advantages of living‐related grafts, optimal graft length, and choice of vascular reconstruction in SBT are yet to be explored.     

Treatment of short gut syndrome with early living related small bowel transplantation

AIM: To investigate the results of treating short bowel syndrome with an early living related small bowel transplantation (SBT). METHODS: A 17-year-old boy with a 20-cm-long residual intestine due to necrotic volvulus received an early living related SBT from his mother. Donor-specific blood transfusion was performed for 8 weeks before transplantation, each time for 50 mL every week. Cytomegalovirus status in both donor and recipient was negative. A 160-cm distal ileal segment was removed from the donor. The graft ilecolic artery and vein were anastomosed to the recipient's infrarenal aorta and caval vein. The proximal end of the graft was anastomosed end-to-end to the residual recipient jejunum; the distal anastomosis, between the distal end of the graft and transverse colon. An ileostomy was also performed. Immunosuppression, infection prophylaxis, and antithrombotic and nutrition support were given postoperatively. RESULTS: The donor had an uneventful recovery. No technical complications were observed. The recipient was alive and well at 31 weeks after the operation. No graft rejection or infection was observed. He was off TPN 8 weeks after the operation and took low-fat food. The D-xylose test in the recipient was almost normal. CONCLUSIONS: Early living related small intestine transplantation is a good treatment for short bowel syndrome.     

Vascular anastomosis and two-stage reconstruction of the gut in a living-related small bowel transplant recipient: a case report

AIM: We sought to discuss vascular anastomosis and gut reconstruction in a living-related small bowel transplantation recipient. METHODS: Living-related small bowel transplantation was performed successfully on a boy with short gut syndrome in two stages. In the first stage, 120 cm, of his mother's ileum was implanted into the recipient with the artery and vein anastomosed to the recipient's sigmoid artery and inferior mesenteric vein, respectively. The two ends of the implanted intestine were constructed as stomas. In the second stage, reconstruction of the continuity of the digestive tract was performed at 188 days after the initial transplantation. The residual small bowel was transected and both ends were anastomosed to the proximal and distal end of the graft in end-to-side fashion. The stomas were closed 30 and 43 days later. RESULTS: Both procedures were successful. Postoperative cytomegalovirus infection and acute rejection occurred successively and were controlled. No leakage of the reconstructed gut or other complications developed after the second procedure. The recipient is alive at 15 months with 8 kg an increase in weight. He is caring for himself independently and has a half-liquid diet, sometimes supplied with auxiliary enteral nutrition. A d-xylose test increased from 4.25% to 25% after the small bowel transplantation. CONCLUSIONS: Vascular anastomoses should be performed according to the state of graft and the recipient. The portal route is the first choice when possible. A two-stage gut reconstruction could decrease the incidence of complications, and offer a useful method in living-related small bowel transplantation.     

Liver transplantation using grafts of living donors with isolated unconjugated hyperbilirubinemia: a matched case–control study

Unconjugated bilirubin has shown both cytotoxic and cytoprotective effects, acting as either an oxidant or an antioxidant. Elevated unconjugated bilirubin with otherwise normal, so‐called isolated unconjugated hyperbilirubinemia (IUHB), is encountered frequently in living liver donor evaluation. However, the significance of IUHB on transplantation‐related outcomes has not been clarified in donors and recipients. Forty‐six living donors with IUHB were matched 1:1 with the control donors and 43 recipients who received grafts from donors with IUHB were matched 1:1 with the control recipients. Matched variables included donor/recipient age, residual liver volume, steatosis, cold ischemic time, graft versus recipient weight ratio, the MELD score and others. Donors in the control and IUHB group were comparable regarding the maximum postoperative transaminase concentrations, postoperative complications, and hospital stay. Recipients in the control and IUHB group were comparable regarding primary graft dysfunction, major postoperative complications, long‐term ICU/hospital stay, 1‐year mortality, and rejection rate, as well as recipient/graft survival rates. Recipients' unconjugated bilirubin concentration at 3 years after transplantation was higher in IUHB group with otherwise comparable liver function. It was concluded that living donor liver transplantation is safe for donors with IUHB and their recipients.     

Five-year follow-up after pediatric living related small bowel transplantation between two monozygotic twins

Two 13-year-old monozygotic twins were used for living related small bowel transplantation (SBTx). The recipient presented with short gut syndrome secondary to complicated abdominal surgery. The indication for SBTx was based on a failure to thrive and a poor tolerance of TPN. The donor was an identical twin, as demonstrated by skin graft acceptance, which allowed performance of SBTx without immunosuppression. Growth charts were used to follow intestinal absorption functions and body composition. The donor was used as a control for the recipient. The recipient, who was transplanted with 160 cm of donor ileum, was discharged on postoperative day 62 on a regular diet. Before SBTx the recipient was 10 kg lighter in body weight than the donor, a gap that was progressively reduced over the follow-up period. A height deficit of 3 cm reversed within 1 year after SBTx. A 10-kg deficit in fat-free body mass was completely extinguished within 18 months. By 18 months posttransplant, recipient serum albumin and prealbumin were normal and comparable to donor values. d-Xylose absorption in the recipient remained lower than that in the donor. Within 6 months fecal fat excretion normalized in the recipient. d-Xylose absorption and fecal fat excretion were always within a normal range in the donor.