背景:2017年2月2日,韩国W医院的10名董事会认证的手专家的手术团队在Yeungnam大学医学中心(YUMC)成功进行了全国首例手移植。本文报道了法律,金融,以及克服了文化障碍,为手术后36个月的手移植及其功能结局开辟了道路。
方法:W医院与大邱市和YUMC达成了谅解备忘录,以遵守政府关于手移植的规定。媒体发起了运动,以提高公众的认识和理解。在城市的财政和法律支持以及大学的医疗合作下,一个外科团队从一名脑死亡的48岁男子到一名35岁的左撇子男子进行了左前臂远端手移植。
结果:通过这次成功的同种异体移植,《韩国器官移植法》现已修订,包括手移植。韩国国民健康保险也已开始涵盖手部移植。术后36个月的功能结果显示,运动和感觉功能均令人满意。手臂的残疾,肩膀,手的得分是23分。最终的手移植评分为90分。功能性脑磁共振成像显示皮质脊髓束的显着皮质重组,并观察到内在肌肉的神经支配。
结论:前臂远端手移植在功能、美学,和心理方面。长期以来,针对手移植的法律和财务障碍一直是最繁重的问题。尽管取得了如此重大的成功,由于韩国医生和人民的接受有限,血管化复合同种异体移植没有其他临床应用。需要进一步开展针对血管化复合同种异体移植的公共教育运动,以提高认识和接受度。
BACKGROUND: On February 2, 2017, the surgical team of ten board-certified hand specialists of W Hospital in Korea successfully performed the nation\'s first hand transplantation at Yeungnam University Medical Center (YUMC). This paper reports on the legal, financial, and cultural hurdles that were overcome to open the way for hand transplantation and its functional outcomes at 36 months after the operation.
METHODS: W Hospital formed a memorandum of understanding with Daegu city and YUMC to comply with government regulations regarding hand transplantation. Campaigns were initiated in the media to increase public awareness and understanding. With the city\'s financial and legal support and the university\'s medical cooperation, a surgical team performed a left distal
forearm hand transplantation from a brain-dead 48-year-old man to a 35-year-old left-handed man.
RESULTS: With this successful allotransplantation, the Korean Act on Organ Transplantation has now been amended to include hand transplantation. Korean national health insurance has also begun covering hand transplantation. Functional outcome at 36 months after the operation showed satisfactory progress in both motor and sensory functions. The disabilities of the arm, shoulder, and hand score were 23. The final Hand Transplantation Score was 90 points. Functional brain magnetic resonance imaging shows significant cortical reorganization of the corticospinal tract, and reinnervation of intrinsic muscle is observed.
CONCLUSIONS: Hand transplantation at the distal
forearm shows very satisfactory outcomes in functional, aesthetical, and psychological aspects. Legal and financial barriers against hand transplantation have long been the most burdensome issues. Despite this momentous success, there have been no other clinical applications of vascularized composite allotransplantation due to the limited acceptance by Korean doctors and people. Further public education campaigns for vascularized composite allotransplantation are needed to increase awareness and acceptance.