手部異體移植之照護與挑戰

Hand Allotransplantation: Care and Challenges

手部異體移植屬於複合組織同種異體移植，手術相當耗時，術後可顯著改善上肢缺損病人的生活品質。手移植術前須嚴謹評估適合性，術後須參與長期服用抗排斥藥物及復健運動的執行，此外，過程需要跨團隊協同合作，方能移植成功。本文主要論述手移植手術之沿革、手移植手術利弊、手移植術後排斥反應與免疫治療、手移植術後復健及手部功能評量、手移植術前與術後之心理反應及評量，依據手移植面臨之多重挑戰提出針對病人層次及環境層次的因應建議，供臨床決策者參考。

Hand allotransplantation, a composite tissue allograft, is a time-consuming surgical procedure. This procedure has been shown to significantly improve quality of life in patients with upper extremity loss. The suitability of this procedure must be rigorously evaluated before surgery, and long term antirejection drugs and rehabilitation exercises must be carried out after hand transplantation. Moreover, its success requires close collaboration within the multidisciplinary team. Several related issues are addressed in this article, including the history of hand transplantation surgery, the pros and cons of this procedure, rejection response and immunotherapy, rehabilitation and hand function recovery after hand transplantation, and pre- and post-procedure psychological reactions and evaluations. Response suggestions at the patient and environmental level that reflect the multiple challenges involved in hand transplantation are provided as a reference for clinical decision-makers.