应用钛轮钉机械吻合对比手工吻合肾移植动脉的临床研究  

Mechanical versus manual anastomoses for artery in clinical renal transplantation

作　　者：周锋[1] 叶钢[1] 莫华根[1] 严治林[1] 王祥卫[1] 易善红[1] 张远宁[1] 方针强[1] 贾维胜[1] 

机构地区：[1]第三军医大学新桥医院肾病中心泌尿外科,重庆400037

出　　处：《重庆医科大学学报》2009年第9期1207-1209,共3页Journal of Chongqing Medical University

摘　　要：目的：本研究应用钛轮钉血管吻合器作肾移植动脉重建术,以确定其能否快捷而安全地完成大血管吻合。方法：75例因慢性肾衰而接受同种异体肾移植病人,36例采用血管吻合器行供肾动脉与髂内动脉端端吻合术,另39例采用间断缝合端端吻合肾动脉与髂内动脉。然后比较分析两组的动脉吻合时间,血管阻断时间,整个手术时间和血管并发症。结果：钛轮钉吻合移植肾动脉全部成功。钛轮钉的动脉吻合时间为（7.0±6.1）min,缝合组是（16.1±7.2）min（P〈0.01）,血管阻断时间分别为（17.8±6.0）min,（28.1±6.8）min（P〈0.05）;手术总时间分别为（2.2±0.9）h,（2.5±1.2）h（P〉0.05）。用2mm钛轮钉,2只肾下极动脉与腹壁下动脉吻合成功。手术无1例大出血而重新吻合,吻合口通常率达到100%。61例获得随访,随访时间2-5年。吻合器组发生移植肾动脉狭窄1例,而缝合组有3例出现此并发症。结论：血管吻合器吻合血管安全、简便、快捷,血管外翻吻合,内膜对合平整。应用此技术吻合动脉可缩短热缺血时间,降低肾动脉狭窄的发生,因此可提高肾移植效果。Objective：This study compares titanium ring-pin stapler and hand-sutures in the end-to-end anastomosis between renal artery and internal iliac artery in clinical kidney transplant. Methods：In 75 renal allograft recipients, the arterial reconstruction were randomly assigned to anastomoses with either 6/0 interrupted nylon sutures（39 patients） or titanium ring-pin stapler（36 cases）. Results：Arterial anastomosis with ring-pin stapler was significantly faster（17.8 versus 28.1 min）. In 2 cases, a lower pole artery was successfully anastomosed to the epigastric artery with 2 mm ring. All 75 renal arteries were patented without episodes of postoperative bleeding, or need for revision of the anastomosis in both groups. Mechanical anastomosis resulted in slightly but not statistically significantly less artery stenosis during 2-5-year follow-up.Conclusion：Renal artery anastomosis with ring-pin stapler is as safe and effective as hand-suture. The time required for mechanical anastomosis is only about 1/2 that required for suture anastomosis.

关 键 词：肾移植 钛轮钉 吻合 

分 类 号：R699[医药卫生—泌尿科学]