上腹部器官簇移植的消化道重建与术后处理

目的探讨上腹部器官簇移植术中消化道重建和手术后处理的方法。方法回顾性分析中山大学附属第一医院于2004年5月为1例胰腺癌合并多发性肝脏转移患者成功实施的亚洲首例上腹部器官簇移植资料。结果术中切除了患者的肝脏、胆囊、胰腺、十二指肠及近端部分空肠、全胃、脾脏、大小网膜等脏器。采用Roux-en-Y方式进行消化道重建:供体十二指肠近端封闭,受体近端空肠与供体十二指肠水平部吻合,吻合口下方35cm处切断受体空肠,断端远端口与食管行端侧吻合,近端口与距离食管吻合口50cm的空肠行端侧吻合。十二指肠腔内置减压管自受体空肠引出体外,Roux-en-Y吻合口远端空肠造瘘置营养管。术后应用生长抑素控制胰液分泌,尽早使用肠内营养,延迟拔除胃管及十二指肠减压管。患者术后恢复顺利,第3天移植胰腺内分泌功能已发挥作用,移植肝脏功能基本正常;消化道功能恢复顺利,第4天肠道排气排便,逐渐恢复至普通饮食;术后1个月除出现腹泻症状外,无其他并发症出现,肝功能及胰腺外分泌功能各项指标均正常。结论上腹部器官簇移植的成功为消化道重建及其手术后处理提供了经验。

Digestive tract reconstruction and postoperative management of upper abdominal multivisceral transplantation

Objective To explore the method of digestive tract reconstruction and postoperative management in the upper abdominal multivisceral transplantation(MVT).Methods The data of a pancreatic cancer patient with multiple liver metastases,undergone the first upper abdominal MVT in Asia on May 2004,was investigated retrospectively.Results During the operation,liver,gall bladder,pancreas,duodenum,part of jejunum,total stomach,greater and lesser omentum,and spleen were all resected from the recipient.Roux-en-Y procedure was adopted for the reconstruction of digestive tract,including closing the proximal end of donor duodenum,anastomosing recipient jejunum with horizontal part of donor duodenum,transecting the jejunum 35 cm from the anastomosis,end-to-side anastomosing the distal cut end of jejunum with the end of esophagus,and end-to-side anastomosing proximal cut jejunum with jejunum 50 cm away from esophageal anastomosis.Drainage tube was left inside duodenum and jejunum stoma was made for nutrient canal.The endocrine of pancreas was suppressed by the use of somatostatin postoperatively.Removing of nasogastric tube and duodenum draining tube were delayed.Bowel function recovered 4 days postoperatively and gradually resumed ordinary diet.One month after operation,the patient had no other complications except diarrhea.Conclusion The success of upper abdominal MVT supplies precious experience in digestive tract construction and postoperative management