医学课件-器官移植.pptVIP

肝移植的类型 经典原位肝移植 背驮式原位肝移植 劈离式肝移植 活体肝移植 副肝移植 多米诺肝移植 原位肝移植的手术方式 供肝的获取 通常与其他脏器联合获取 – 心/肺/肾/胰腺 脑死亡的尸体供体 评估肝脏的匹配程度–外科医师视觉评定 预后的关键在于肝功能 供体肝切除 暴露 – 正中切口 打开镰状韧带和三角韧带 血供 – 结扎胃十二指肠动脉, 解剖肝动脉知道腹腔干水平 分离胆总管下段 解剖门静脉并夹闭 分离肝上、肝下下腔静脉(切除肝静脉) 主动脉和门静脉置管 浸泡在低温保存液中 Vena cava of donor liver Portal vein and hepatic artery of donor liver 受体肝切除 腹部人字形切口 游离肝脏 – 打开冠状和镰状韧带 游离肝门 分离肝动脉 在门静脉右侧分离胆总管 解剖门静脉并将其横断 解剖出IVC肝上段和肝下段并钳夹 取出肝脏 移植受体 硬化的肝脏 巨脾 严重的静脉侧支循环 结扎肝门 急性排斥 大约10 天后发生 大量巨噬细胞和淋巴细胞浸润。 慢性排斥 几个月或几年后发生。 包括体液和细胞免疫。 免疫抑制 免疫抑制剂 Antimetablites Azathioprine Mycophenolate mofetil Antibodies Monoclonal Anti-CD3 Interleukin-2 receptor antagonist Polyclonal Anti-lymphacyte immunoglobulin Anti-thymocyte immunoglobulin Cytokine inhibitors Corticosteroids Calcineurin inhibitors Cyclosporin Tacrolimus Cell Cycle Inhibitor Sirolimus Immunosuppressive Agent Target Pathway(s) Pharmacologic Corticosteroids (a) Selective lysis of immature cortical thymocytes (b) Blockade of cytokine gene transcription in APC Cyclosporin (Sandimmune, Neoral, Gengraf) Signal 1 transduction via TCR Tacrolimus (Prograf) Signal 1 transduction via TCR Rapamycin/Sirolimus and Everolimus/SDZ RAD Signal 3 transduction via IL-2 receptor (Rapamune and Certican) Azathioprine (Imuran) Inhibition of purine metabolism and DNA synthesis Mycophenolic acid (CellCept, Myfortic) Inhibition of purine metabolism and DNA synthesis Biological Anti-CD3 pan-T cell (Orthoclone OKT3) (a) Causes depletion and receptor modulation in T cells (b) Interferes with Signal 1 Anti-thymocyte globulin (ATGAM, Thymoglobulin) (a) Causes depletion and receptor modulation in T cells (b) Interferes with Signal 1, 2 and 3 (c) Inhibits lymphocyte trafficking Anti-IL-2 α-chain receptor (Zenapax, Simulect) Inhibits T cell proliferation to IL-2 (Signal 3) Anti-CD52 (Campath 1-H) Causes depletion of thymocytes, T