婴幼儿供者器官联合切取时供肾切取和修整方法的探讨  

The optimized technique of excision and trim of kidney from small pediatric donors

作　　者：刘毅[1] 杨先振[1] 宋华[1] 常征[1] 沈弋桢[1] 张爱民[1] 郝俊文[1] 刘少鸽[1] 李香铁[1] 

机构地区：[1]济南军区总医院泌尿外科全军肾移植与透析治疗中心,250031

出　　处：《中华移植杂志（电子版）》2015年第1期26-29,共4页Chinese Journal of Transplantation(Electronic Edition)

摘　　要：目的探讨婴幼儿供者肝肾联合切取时供肾切取和修整方法。方法 2012年8月至2013年5月,济南军区总医院成功完成5例婴幼儿心脏死亡器官捐献（DCD）供肾肾移植。5例婴幼儿供者中,男性4例,女性1例,中位年龄9个月（0.5~27个月）,中位体质量为10 kg（4~14 kg）,死亡原因为颅脑外伤4例、溺水1例;采用腹部器官联合切取法,取腹部＂十字＂切口,原位经单侧髂总动脉和门静脉插管,分别以0~4℃UW液2 000 m L灌洗,灌注压力约为80 cm H2O（1 cm H2O=0.098 k Pa）;联合切取肝、肾,在工作台分离肝脏和肾脏,修整供肾。5例成人受者中,男性4例,女性1例,中位年龄37岁（28~38岁）,中位体质量64kg（44~68 kg）,原发病均为慢性肾小球肾炎;术前接受血液透析4例,接受腹膜透析1例,中位透析时间为17个月（6~30个月）。结果 5例成人受者均为首次肾移植,采用双肾整体移植术式,腹主动脉和下腔静脉远端与髂血管吻合,膀胱瓣与膀胱吻合或输尿管分别与膀胱吻合。供肾热缺血时间中位数为5 min（4~10 min）,器官灌注良好,无血管损伤;冷缺血时间中位数为6 h（5~10 h）。1例受者术后1个月发生移植肾功能延迟恢复,血清肌酐维持在200μmol/L;其余4例受者术后6~9 d血清肌酐恢复正常,其中1例术后32 d发生移植肾动脉破裂导致受者死亡。1例受者术后14 d发生尿漏,再次手术后恢复。术后随访12~21个月,4例受者存活。结论婴幼儿DCD供器官切取较成人供者难度大,正确的供肾切取、保存及修整方法是保证移植成功的关键因素。Objective To explore the technique of excision and trim of the small pediatric donors kidney during en bloc kidney transplantation. Methods We successfully harvested liver and kidney together on five pediatric donation after cardiac death （DCD）. Four cases were male and one was female. The median age was 9 months. Wide surgical exposure was obtained. Cannulas were placed in situ in unilateral iliac artery and portal vein, and flushed with hypothermia UW （2 000 mL） with the pressure being 80 cmH20. The liver and kidney were en bloc excised and isolated, and the kidney was trimmed. En bloc kidney transplantation was performed in five adult recipients. Results Excisions of donative abdominal organs were successfully performed on all five cases. The median en bloc warm isehemic time of kidney was 5 mix （4-10 mix）. The median cold isehemic time was 6 h （5-10 h）. The serum creatinine levels were normal in four cases at 6-9 days after operation while 200 p, mol/L in one case with delayed graft function. One case was died at 32 day due to transplanted renal artery hemorrhage. Urine leak occurred at 14 days after operation and was treated by reoperation in one case. Four recipients were alive after a follow-up period of 12-21 months. Conclusions Procurement and trim of kidney from small pediatric donors was difficulty than that in adult donors.Technology of excision, preservation and finishing on donor kidney for combined en bloc kidney transplantation was one of the key points for successful transplantation.

关 键 词：肾移植 供者 组织和器官获取 婴幼儿 

分 类 号：R699.2[医药卫生—泌尿科学]