同种异体非整块肝脏-小肠联合移植

目的 报告国内首例同种异体非整块肝肠联合移植,重点讨论外科技术,并与整块肝肠联合移植技术进行比较。方法 患者因短肠综合征和全肠外营养(TPN)肝病接受非整块肝肠联合移植,植入小肠380cm。肠系膜上动脉、门静脉分别与受体腹主动脉、下腔静脉端侧吻合;供肝行改良背驮式肝移植。供体热缺血时间为2min 30s,移植肠冷缺血6h 40min,移植肝冷缺血8h 7min．术后免疫抑制方案采用FK506 激素 骁悉 赛尼哌。结果 患者恢复顺利,未发生排斥反应,至今仍存活,已恢复完全肠道营养。结论 非整块肝肠联合移植技术适合于成年受体、特别是既往曾有腹腔感染或接受多次腹部手术的患者。

Non-composite combined liver and intestinal allotransplantation

OBJECTIVE: To report the first case of non-composite combined liver and intestinal allotransplantation in China. The technical aspects of the case and pros and cons of such an approach versus composite technique were discussed. METHODS: The patient suffered from short bowel syndrome and TPN-related liver damage. A non-composite technique was used in this case. During operation, the whole 380 cm intestine was transplanted with systemic drainage and aortic inflow, while the liver graft was placed in a piggyback fashion. Warm ischemic time of donor graft was 2 min and 30 seconds, and cold ischemic duration for intestinal and liver graft was 6 hours and 40 and 8 hours and 7 utes respectively. Postoperative immunosuppression management includes tacrolimus, methylprednisolone, MMF and Zenapax. RESULTS: The recipient recovered smoothly with no evidence of rejection on days' follow up. Now he is maintained well on enteral nutrition. CONCLUSION: Non-composite technique should be considered in adult recipients, especially those with a history of abdominal infections or multiple laparotomies.