成功的上腹部器官簇移植1例：供体器官的切取及修整-_0.docVIP

成功的上腹部器官簇移植1例：供体器官的切取及修整* 作者：朱晓峰 何晓顺 马 毅 王东平 钱世 鞠卫强 巫林伟 张相良 【摘要】 目的 探讨上腹部多器官移植中器官簇的切取、修整、血管整形 方法 及移植效果。方法 供体器官簇获取采用腹部多器官联合切取，腹主动脉、肠系膜上静脉、胆管及十二指肠同时灌注降温。器官簇肠系膜上动脉和腹腔干分别与供体髂内、外动脉吻合，通过髂总动脉与受体腹主动脉吻合。受体为胰腺囊腺癌并肝内转移患者，行上腹部肝、胆、胰、脾、十二指肠、全胃、空肠上段及大小网膜切除，接受肝、胰、十二指肠器官簇移植。结果 移植后器官簇存活及功能良好，肝、胰功能均在术后4天恢复正常，患者现已完全康复，未出现明确并发症。结论 获取质量良好的上腹部器官簇及合理血管整形，是保证移植效果的前提；上腹部器官簇移植是 治疗 上腹局部晚期肿瘤的有效方法。 【关键词】 器官簇移植 供体切取及修整 上腹部 Successful of transplantation of epigastric multiorgan cluster in 1 case：procurement and trim of donor 【Abstract】 Objective To study the methods of procurement，trim and arterioplasty of donor epigastric multivisceral cluster，and the effect of the cluster transplantation.Methods The donor multivisceral cluster was procured simultaneously with the kidneys.The donor aorta，superior mesentery vEin，biliary and duodenum were perfused with cool UW solution at the same time.The donors superior mensentery artery and coeliac artery were respectively anastomosed to donor’s interior and exterior artery leading to common iliac artery which was anastomosed to the recipient’s aorta.The recipient suffered from cystic pancreatic cancer with multiple metastasis within liver.The recipient’s abdominal organs including liver，gallbladder，pancreas，spleen，duodenum，stomach，proximal jejunum and omentus were totally removed.The organ cluster including liver，pancreas and duodenum was transplanted.Results Liver and pancreas graft function returned to normality 4 days after transplantation.The reciprient recovered completely.Conclusion The procurement of good quality of donor organ cluster and suitable arterioplasty are the precondition of excellent effect of transplantation，the transplantation of epigastric multiorgan cluster would be effective therapy of local metastasis of epigastric cancer. 【Key words】 transplantation of epigastric multiorgan cluster procurement and trim of donor epigastrium 1989年Starzl［1］和Williams［2］分别报道了腹部多器官联合移植，以后该术式在欧美发达国家取得了相当成功的经验，为腹腔一些侵犯多个脏器的终末期疾病提供了一条根治的新途径。200