活体肾移植开放手术取肾88例分析  

Open procurement in living donor kidney transplantation:a report of 88 cases

作　　者：鄢业鸿[1] 李剑锋[1] 肖建生[1] 单人锋[1] 谢青松[1] 王共先[1] 

机构地区：[1]南昌大学第一附属医院器官移植科,330006

出　　处：《中华移植杂志（电子版）》2009年第3期154-157,共4页Chinese Journal of Transplantation(Electronic Edition)

摘　　要：目的总结单中心开放手术活体取肾经验及分析术后并发症,以期强化对供者术后管理及随访的重视。方法回顾性分析南昌大学第一附属医院自2005年12月至2009年7月所行开放手术活体取肾88例手术情况及术后并发症。结果本组供者出血量80～200 mL,术中均无输血,手术时间2～3 h,所有副肾动脉、多支肾静脉均成功重建,平均于术后1周出院;25例(28.41%)供者发生28例次(31.82%)与正常术后恢复过程背离的不良事件,其中6.8%符合改良的Clavien外科并发症分级Ⅰ～Ⅱ级。结论重视供肾血管的术前影像学评估和术中探查是肾动静脉成功重建的保障。供肾切取手术是一种风险低但轻度并发症较多的手术,应加强围手术期管理和长期随访。有必要制订适用于评定供肾切取术后并发症的分级标准。Objective To summarize experience of open procurement and surgical complications in living donor kidney transplantation （LDKT） in a single center, in an attempt to appeal attention to the postoperative management and follow-up of donors. Methods A total of 88 cases of donor graft procurement with open surgery by single surgeon were performed from December 2005 to July 2009 in Department of Organ Transplantation, the First Affiliated Hospital of Nanchang University. Surgeries and surgical complications were retrospectively analyzed. Modified Clavien classification sytem was used to evaluate the surgical complications. Results No blood transfusion was required in all nephrectomy, the total volume of blood lose was from 80 mL to 200 mL in different cases, and the time of operation was 2-3 h. All accessory renal arteries and multiple veins were successfully reconstructed. All donors were discharged within one week postoperatively. Twenty-eight （31.82%） episodes of adverse events occurred in 25 （28.41%） donors, 6.8% of which were fallen into the Clavien Ⅰ and Ⅱcomplications. Conclusions Both preoperative evaluation and intraoperative exploration are equally important for the vessel reconstruction. The open procurement in LDKT is a safe procedure with relatively high morbidity of mild complications, so great attention should be paid for the perioperative care and long term followup for the donors. Standard complication diagnosis criteria for the living donor kidney procurement are essential for evaluation of the operation quality.

关 键 词：肾移植 活体供者 开放手术取肾 外科并发症 改良的Clavien分级系统 

分 类 号：R699.2[医药卫生—泌尿科学] R692.4[医药卫生—外科学]