J. Meyburg, F. Hoerster, J. Weitz, G.F. Hoffmann, J. Schmidt

简介：由于创伤较小，门静脉内肝细胞移植（LCT）比全器官移植更受关注。我们常常选择肠系膜静脉作为门静脉通路。但是小儿患者常常出现解剖学变异，因此我们研究将导管置入结肠中静脉。

患者和方法：在本移植中心共有3名儿童（年龄在3周至3岁，体重在3至4kg之间）由于急性肝功能衰竭或严重的新生儿尿素循环障碍而进行了LCT。我们通过手术将一根小而有弹性的Hickman导管置入结肠中静脉或门静脉。患者通过该Hickman导管反复输注肝细胞，持续4至11天。

结果: 尽管1名患者的临床效果较差，其他2名患者出现代谢不稳定症状，但是该研究结果仍然表明导管置入是可行的，患者对其也能很好的耐受。血液应该流经所有的导管，同时在2名小儿患者身上可以测出门静脉压力。患有急性肝功能衰竭的患者在11天后由于其他疾病出现并发症而导致死亡。另外2名儿童患者的门静脉导管在体内保留了数月之久。

结论：我们推荐在患者结肠中静脉内放置门静脉LCT导管，该法即使是对小儿患者和危重病的婴儿也同样适用。

Use of the Middle Colic Vein for Liver Cell Transplantation in Infants and Small Children
J. Meyburg, F. Hoerster, J. Weitz, G.F. Hoffmann, J. Schmidt

Introduction：Because it is less invasive, intraportal liver cell transplantation (LCT) is an interesting alternative to whole organ transplantation. The inferior mesenteric vein is usually chosen for portal vein access. However, anatomical variations are common in children, so we investigated catheter insertion into the middle colic vein.

Patients and Methods：Three children (3 weeks to 3 years; 3 to 14 kg) underwent LCT in our center for acute liver failure or severe neonatal urea cycle disorders. Small 4.2-French Hickman lines were surgically introduced into the middle colic vein and advanced to the portal vein stem. The patients received repetitive infusions of liver cells over a period of 4–11 days.

Results：Catheter insertion was feasible and tolerated well despite the poor clinical condition of 1 patient and the metabolic instability in the other 2 patients. Blood could be drawn from all catheters, and measurement of portal vein pressure was possible in 2 children. The patient with acute liver failure died after 11 days from complications of the underlying disease. In the other 2 children, portal vein catheters stayed patent for several months.

Conclusions：The middle colic vein can be recommended for placement of intraportal LCT catheters even in small and critically ill infants.

Volume 40, Issue 4, Pages 936-937 (May 2008)

[责任编辑:刘 聪]