肝胰十二指肠器官簇移植外科技术

2004年9月1例原发性肝癌合并胰头转移的患者在我院接受肝胰十二指肠器官簇移植，整块切除全肝、胆囊、十二指肠、胰腺、脾脏、胃大部和部分上段空肠，进行了血管和消化道重建。移植后胰腺功能正常，未应用胰岛素维持。术后第4d肠道功能恢复，术后1周肝功能恢复正常；术后16d时因腹腔内出血行剖腹探查血肿清除术，同时对感染伤口进行减张缝合，愈合良好；术后2月时出现不全性肠梗阻症状，保守治疗后好转。患者目前已存活5个月，肝脏和胰腺功能均正常，痊愈出院。肝胰十二指肠器官簇移植术的成功为上腹部晚期恶性肿瘤患者提供了延长生命的机会，同时为晚期肝病伴有胰腺功能不良患者的彻底治愈探索出新的手术方式。

Combined ‘En Bloc’ Liver and Pancreas Transplantation

To introduce a case of primary hepatic carcinoma with pancreatic metastasis who underwent combined 'en bloc' liver and pancreatic transplantation in September, 2004. After 'en bloc' resection of liver, gallbladder, duodenum, pancrease, spleen, distal stomach and proximal jejunal loop, the recipient underwent vascular and alimentary tract reconstruction. The postoperative course demonstrated insulin-independent right after transplantation, bowel functional rehabilitation in 4 days, hepatic functional rehabilitation in 1 week. A laparotomy and hemotoma debridement performed at 16th day postoperatively due to peritoneal hemorrhage. A secondary wound suture carried out due to wound infection and result in good heal. Incomplete intestinal obstruction occured in 2 months postoperatively and relieved by conservative treatment. The patient survived for 5 months so far and discharged with normal hepatic and pancreatic function. The cluster transplantation contributes a chance to prolong the life for the patients surfering from upper abdominal unresectable malignant tumor, and creates a new approach to cure the terminal-stage liver disease associated with pancreatic dysfunction.