活体肾移植供肾动脉解剖学特点及其处理的临床体会  

Anatomy character of renal artery and treatment of living donor renal transplantation

作　　者：张磊[1] 费继光[1] 陈立中[1] 王长希[1] 邓素雄[1] 邱江[1] 李军[1] 陈国栋[1] 黄刚[1] 

机构地区：[1]中山大学附属第一医院器官移植中心,广州510080

出　　处：《中华外科杂志》2009年第24期1879-1882,共4页Chinese Journal of Surgery

基　　金：基金项目：中山大学临床医学研究5010计划进一步提高肾移植疗效的临床研究（2007003）

摘　　要：目的总结活体肾移植供者肾动脉解剖学特点及多支动脉供肾的手术处理方式。方法分析我中心142例活体肾移植供者术前数字减影血管造影和CT血管成像的供肾动脉解剖结果。用6种不同方式对多支动脉供肾进行显微技术处理，比较供肾多支动脉受者（n=31）与供肾单支动脉受者（n=111）术后早期的临床疗效。结果30．99％的供者存在肾脏多支动脉，两侧肾脏相似（左肾22．54％，右肾22．13％），在一侧存在时，对侧也存在的概率分别为56．25％和60．00％。左肾动脉主干稍粗（P=0．001）且主干上第1个分支距腹主动脉距离稍近（P=0．004）。多支动脉组受者手术时间和供肾冷、热缺血时间延长，但在术中出血量、移植肾功能延迟恢复、急性排斥反应及移植肾彩超弓形动脉流速等方面与单支动脉组差异并无统计学意义。在术后7d、1个月、3个月3个观察点2组受者血清肌酐和肌酐清除率相似，重复测量的方差分析还表明供肾是否为多支动脉对术后早期肾功能的变化趋势并无影响。结论充分了解活体供肾的动脉解剖并采用正确的处理方式是保证移植效果的重要因素。Objective To study the anatomy characters of renal artery and the treatment of multiple arteries in living donor renal grafts. Methods Records of 142 living donors were analyzed in our center. We analyzed the anatomic structure of renal arteries by DSA and CTA pre-transplantation. Thirty-one kidneys with multiple arteries were transplanted after reconstruction. Then clinical effects were compared between multiple-renal-arteries group （ n = 31 ） and single-renal-artery group （ n = 111 ）. Results The incidence of multiple renal artery was 30. 99% , and there was no difference between both sides （ left kidney 22. 54% , right kidney 22. 13% ）. If the multiple artery occurred in left or right kidney, the incidence of the multiple artery occurred in the other side was 56. 25% and 60. 00% , respectively. The diameter of left main renal artery was more magnanimous （ P = 0. 001 ） and the first branch was more closed to abdominal aorta （P = 0. 004）. Operation time and warm/cool ischemia time were longer in the multiple-renal-arteries group. However, estimated blood Ioss, delayed graft function, acute rejection and flow rate of arcuate artery were similar in both groups, the same as serum creatinine and serum ereatinine clearance rate on day 7, 1 month and 3 month post-operation. It was shown by repeated measures ANOVA that graft with multiple arteries didn＇t affect the tendency of renal function at early time post-operation. Conclusion Comprehending the character of renal artery and accurate treatment of multiple artery anastomosis are critical for the effect of the living kidney transplantation.

关 键 词：肾移植 活体供者 肾功能试验 多支动脉 

分 类 号：R686[医药卫生—骨科学]