Adachi Koko, Murakami Noritaka, Sasaki Shigeyoshi, Kurosawa Shin, Horinouchi Takashi, Kato Masato
Department of Anesthesiology and Perioperative Medicine, Tohoku University Graduate School of Medicine, Sendai 980-8574.
Masui. 2005 Aug;54(8):893-7.
Isolated small bowel transplantation allows patients with irreversible small bowel failure to be weaned from total parenteral nutrition (TPN). We reported the first two cases of anesthesia for living related donor small bowel transplantation in our hospital. They had required long-term TPN. This resulted in thrombosis of the major blood vessels which critically restricted vascular access available for TPN, leading to a life-threatening condition for the patients. In patients with known difficult vascular access, performing a magnetic resonance imaging before surgery to evaluate patency of central veins seems reasonable, as well as inserting a central catheter before the surgical procedure. Graft reperfusion may cause hemodynamic instability due to changes in potassium, acid-base status as the preservative solution is flushed out of the implant. Hemodynamic, respiratory parameters and urinary output were well preserved throughout the procedure. Besides, a transitory increase in potassium following graft revascularization and biochemical changes were small. Anesthetic management requires comprehensive preoperative assessment and sufficient management without interfering with intestinal function, optimizing splanchnic perfusion to ensure implant viability.
孤立性小肠移植可使不可逆性小肠衰竭患者摆脱全胃肠外营养（TPN）。我们报告了我院首例两例亲属活体供体小肠移植的麻醉病例。这些患者长期依赖TPN，这导致主要血管血栓形成，严重限制了TPN可用的血管通路，使患者处于危及生命的状态。对于已知血管通路困难的患者，术前进行磁共振成像以评估中心静脉通畅情况以及在手术前插入中心导管似乎是合理的。移植物再灌注可能会因植入物中保存液被冲洗出而导致钾、酸碱状态变化，从而引起血流动力学不稳定。整个手术过程中血流动力学、呼吸参数和尿量均保持良好。此外，移植物血管重建后钾的短暂升高和生化变化较小。麻醉管理需要全面的术前评估和充分的管理，同时不干扰肠道功能，优化内脏灌注以确保植入物的存活。
