小肠移植研究新进展
张喜平, 封光华, 杭州市第一人民医院普外科 浙江省杭州市 310006
杭州市医药卫生科技计划资助项目, NO. 2004BZ005
通讯作者: 封光华,310006, 浙江省杭州市浣纱路261号, 杭州市第一人民医院普外科.
电话: 0571-87065701-11381
收稿日期: 2005-01-06 接受日期: 2005-02-26
摘要由于容易发生排斥反应和感染，小肠移植一直是临床上难度最大的移植手术之一，因此其发展远远落后于其他器官和组织移植的发展水平.自80年代环孢素(CsA)问世以来，小肠移植的病例逐渐增多.进入90年代后，新型的强力免疫抑制剂他克莫司的问世，使小肠移植成功率大大上升，目前仍生存的小肠移植患者，几乎都是因采用了他克莫司而获得成功的.本文从小肠移植临床新技术、移植小肠保存、排斥反应、术后感染、营养支持五个方面对小肠移植近年来的研究做一归纳和阐述.
, 百拇医药
张喜平, 封光华. 小肠移植研究新进展. 世界华人消化杂志 2005;13(8):1008-10101 Grant D. Intestinal transplantation: 1997 report of the international registry. Transplantation 1999;67:1061-1064
2 Goulet O, Revillon Y. Intestinal transplantation. Indian J Pediatr 2003;70:737-742
3 夏穗生. 小肠移植的沿革与新进展. 消化外科 2002;1:307-310
4 Kato T, Ruiz P, Thompson JF, Eskind LB, Weppler D, Khan FA, PinnaAD, Nery JR, Tzakis AG. Intestinal and
, 百拇医药
multivisceral transplantation. World JSurg 2002;26:226-237
5 王果. 小肠移植的进展. 中华小儿外科杂志 1999;20:51-52
6 Thompson JS. Intestinal transplantation. Experience in the UnitedStates. Eur J Pediatr Surg 1999;9:271-273
7 de Franchis R, Rondonotti E, Abbiati C, Beccari G, Merighi A, PinnaA, Villa E. Capsule enteroscopy in small bowel
transplantation. Dig Liver Dis 2003;35:728-731
, 百拇医药
8 王为忠, 宋维亮, 吴国生, 凌瑞, 卜建石, 张少华, 杜建军, 陈冬利, 赵京霞, 薛涌嘉, 董光龙, 张宏伟, 李孟彬,李纪鹏, 刘小南, 季刚, 罗兰. 活体部分小肠移植供受体围手术期的处理. 中华普通外科杂志 2000;15:411-413
9 Miyauchi T, Ishikawa M, Tashiro S, Hisaeda H, Himeno K.Experimental study of combined treatment with tacrolimus
and donor splenocytes via the portal veinin small bowel transplantation. J Med Invest 2001;48:157-165
10 Mitsuoka N, Iwagaki H, Ozaki M, Sheng SD, Sadamori H, Matsukawa H,Morimoto Y, Matsuoka J, Tanaka N, Yagi T.
, 百拇医药
The impact of portal infusion withdonor-derived bone marrow cells and intracellular cytokine expression of
graft-infiltrating lymphocytes on thegraft survival in rat small bowel transplant model. Transpl Immunol
2004;13:155-160
11 Tsujimura T, Salehi P, Walker J, Avila J, Madsen K, Lakey J, KurodaY, Churchill TA. Ameliorating small bowel injury
using a cavitary two-layerpreservation method with perfluorocarbon and a nutrient-rich solution.
, http://www.100md.com
Am J Transplant 2004;4:1421-1428
12 Salehi P, Spratlin J, Chong TF, Churchill TA. Beneficial effects ofsupplemental buffer and substrate on energy
metabolism during small bowelstorage. Cryobiology 2004;48:245-253
13 DeRoover A, De Leval L, Gilmaire J, Detry O, Coimbra C, Boniver J,Honore P, Meurisse M. Luminal contact with
University of Wisconsin solutionimproves human small bowel preservation. Transplant Proc 2004;36:273-275
, 百拇医药
14 王为忠, 宋维亮, 吴国生, 凌瑞, 季刚, 陈冬利, 李孟彬, 刘小南, 赵京霞. 活体部分小肠移植1例报告.
中华器官移植杂志 2001;22:30-32
15 Ruiz P, Garcia M, Pappas P, Berney T, Esquenazi V, Kato T, MittalN, Weppler D, Levi D, Nishida S, Nery J, Miller J,Tzakis A. Mucosal vascularalterations in isolated small-bowel allografts:relationship to humoralsensitization.
Am J Transplant 2003;3:43-49
16 Pappas PA, Tzakis AG, Saudubray JM, Gaynor JJ, Carreno MR, HuijingF, Kleiner G, Rabier D, Kato T, Levi DM,Nishida S, Gelman B, Thompson JF,Mittal N, Ruiz P. Trends in serum citrulline and acute rejection amongrecipients
, 百拇医药
of small bowel transplants. TransplantProc 2004;36:345-347
17 Miyauchi T, Ishikawa M, Tashiro S. Evaluation of the acetaminophenabsorption test for early detection of orthotopic
small bowel transplant rejection. SurgToday 2001;31:695-700
18 Ruiz P, Bagni A, Brown R, Cortina G, Harpaz N, Magid MS, Reyes J.Histological criteria for the identification of
, 百拇医药 acute cellular rejection in humansmall bowel allografts:results of the pathology workshop at the VIIIInternational
Small Bowel Transplant Symposium.Transplant Proc 2004;36:335-337
19 罗宇东, 梁晓宇, 王浩, 朱理玮, 王鹏志. 小鼠小肠移植术后排斥反应标志物研究.
中国中西医结合外科杂志 2001;7:260-262
20 Li Y, Li N, Li J. Intragraft mRNA expression in small intestinalallograft rejection.
, http://www.100md.com
Zhonghua Yixue Zazhi 1999;79:773-776
21 张洪伟, 王为忠, 凌瑞, 李开宗. 临床活体部分小肠移植过程中矛盾现象及处理. 医学与哲学 2001;22:1-3
22 Woodward JM, Mayer D. The unique challenge of small intestinaltransplantation. Br J Hosp Med 1996;56:285-290
23 Trohm SL,Koehler AN, Mazariegos GV, Friedman L, Tchang S. Nutrition management inpediatric small bowel
transplant. Nutr Clin Prac 1999;14:58-68
24 王良友, 潘和平. 谷氨酰胺与谷氨酰胺二肽的临床应用前景. 中国营养杂志 2000;8:178-180
25 Xu D, Lu Q, Deitch EA. Elemental diet-induced bacterialtranslocation associated with systemic and intestinal
immune suppression. J ParenterEnteral Nutr 1998;22:37-41
编辑 张海宁, 百拇医药( 张喜平,封光华)
杭州市医药卫生科技计划资助项目, NO. 2004BZ005
通讯作者: 封光华,310006, 浙江省杭州市浣纱路261号, 杭州市第一人民医院普外科.
电话: 0571-87065701-11381
收稿日期: 2005-01-06 接受日期: 2005-02-26
摘要由于容易发生排斥反应和感染，小肠移植一直是临床上难度最大的移植手术之一，因此其发展远远落后于其他器官和组织移植的发展水平.自80年代环孢素(CsA)问世以来，小肠移植的病例逐渐增多.进入90年代后，新型的强力免疫抑制剂他克莫司的问世，使小肠移植成功率大大上升，目前仍生存的小肠移植患者，几乎都是因采用了他克莫司而获得成功的.本文从小肠移植临床新技术、移植小肠保存、排斥反应、术后感染、营养支持五个方面对小肠移植近年来的研究做一归纳和阐述.
, 百拇医药
张喜平, 封光华. 小肠移植研究新进展. 世界华人消化杂志 2005;13(8):1008-10101 Grant D. Intestinal transplantation: 1997 report of the international registry. Transplantation 1999;67:1061-1064
2 Goulet O, Revillon Y. Intestinal transplantation. Indian J Pediatr 2003;70:737-742
3 夏穗生. 小肠移植的沿革与新进展. 消化外科 2002;1:307-310
4 Kato T, Ruiz P, Thompson JF, Eskind LB, Weppler D, Khan FA, PinnaAD, Nery JR, Tzakis AG. Intestinal and
, 百拇医药
multivisceral transplantation. World JSurg 2002;26:226-237
5 王果. 小肠移植的进展. 中华小儿外科杂志 1999;20:51-52
6 Thompson JS. Intestinal transplantation. Experience in the UnitedStates. Eur J Pediatr Surg 1999;9:271-273
7 de Franchis R, Rondonotti E, Abbiati C, Beccari G, Merighi A, PinnaA, Villa E. Capsule enteroscopy in small bowel
transplantation. Dig Liver Dis 2003;35:728-731
, 百拇医药
8 王为忠, 宋维亮, 吴国生, 凌瑞, 卜建石, 张少华, 杜建军, 陈冬利, 赵京霞, 薛涌嘉, 董光龙, 张宏伟, 李孟彬,李纪鹏, 刘小南, 季刚, 罗兰. 活体部分小肠移植供受体围手术期的处理. 中华普通外科杂志 2000;15:411-413
9 Miyauchi T, Ishikawa M, Tashiro S, Hisaeda H, Himeno K.Experimental study of combined treatment with tacrolimus
and donor splenocytes via the portal veinin small bowel transplantation. J Med Invest 2001;48:157-165
10 Mitsuoka N, Iwagaki H, Ozaki M, Sheng SD, Sadamori H, Matsukawa H,Morimoto Y, Matsuoka J, Tanaka N, Yagi T.
, 百拇医药
The impact of portal infusion withdonor-derived bone marrow cells and intracellular cytokine expression of
graft-infiltrating lymphocytes on thegraft survival in rat small bowel transplant model. Transpl Immunol
2004;13:155-160
11 Tsujimura T, Salehi P, Walker J, Avila J, Madsen K, Lakey J, KurodaY, Churchill TA. Ameliorating small bowel injury
using a cavitary two-layerpreservation method with perfluorocarbon and a nutrient-rich solution.
, http://www.100md.com
Am J Transplant 2004;4:1421-1428
12 Salehi P, Spratlin J, Chong TF, Churchill TA. Beneficial effects ofsupplemental buffer and substrate on energy
metabolism during small bowelstorage. Cryobiology 2004;48:245-253
13 DeRoover A, De Leval L, Gilmaire J, Detry O, Coimbra C, Boniver J,Honore P, Meurisse M. Luminal contact with
University of Wisconsin solutionimproves human small bowel preservation. Transplant Proc 2004;36:273-275
, 百拇医药
14 王为忠, 宋维亮, 吴国生, 凌瑞, 季刚, 陈冬利, 李孟彬, 刘小南, 赵京霞. 活体部分小肠移植1例报告.
中华器官移植杂志 2001;22:30-32
15 Ruiz P, Garcia M, Pappas P, Berney T, Esquenazi V, Kato T, MittalN, Weppler D, Levi D, Nishida S, Nery J, Miller J,Tzakis A. Mucosal vascularalterations in isolated small-bowel allografts:relationship to humoralsensitization.
Am J Transplant 2003;3:43-49
16 Pappas PA, Tzakis AG, Saudubray JM, Gaynor JJ, Carreno MR, HuijingF, Kleiner G, Rabier D, Kato T, Levi DM,Nishida S, Gelman B, Thompson JF,Mittal N, Ruiz P. Trends in serum citrulline and acute rejection amongrecipients
, 百拇医药
of small bowel transplants. TransplantProc 2004;36:345-347
17 Miyauchi T, Ishikawa M, Tashiro S. Evaluation of the acetaminophenabsorption test for early detection of orthotopic
small bowel transplant rejection. SurgToday 2001;31:695-700
18 Ruiz P, Bagni A, Brown R, Cortina G, Harpaz N, Magid MS, Reyes J.Histological criteria for the identification of
, 百拇医药 acute cellular rejection in humansmall bowel allografts:results of the pathology workshop at the VIIIInternational
Small Bowel Transplant Symposium.Transplant Proc 2004;36:335-337
19 罗宇东, 梁晓宇, 王浩, 朱理玮, 王鹏志. 小鼠小肠移植术后排斥反应标志物研究.
中国中西医结合外科杂志 2001;7:260-262
20 Li Y, Li N, Li J. Intragraft mRNA expression in small intestinalallograft rejection.
, http://www.100md.com
Zhonghua Yixue Zazhi 1999;79:773-776
21 张洪伟, 王为忠, 凌瑞, 李开宗. 临床活体部分小肠移植过程中矛盾现象及处理. 医学与哲学 2001;22:1-3
22 Woodward JM, Mayer D. The unique challenge of small intestinaltransplantation. Br J Hosp Med 1996;56:285-290
23 Trohm SL,Koehler AN, Mazariegos GV, Friedman L, Tchang S. Nutrition management inpediatric small bowel
transplant. Nutr Clin Prac 1999;14:58-68
24 王良友, 潘和平. 谷氨酰胺与谷氨酰胺二肽的临床应用前景. 中国营养杂志 2000;8:178-180
25 Xu D, Lu Q, Deitch EA. Elemental diet-induced bacterialtranslocation associated with systemic and intestinal
immune suppression. J ParenterEnteral Nutr 1998;22:37-41
编辑 张海宁, 百拇医药( 张喜平,封光华)
