后腹腔镜老龄活体供肾肾移植临床分析  

Clinical analysis on effect of retroperitoneoscopic nephrectomy in elderly donors for renal transplantation

作　　者：罗用文 李钢 王振 范宇 柏宏伟 常京元 贺腾辉 钱叶勇 

机构地区：[1]解放军第三0九医院器官移植研究所泌尿二科,北京100091

出　　处：《中华医学杂志》2016年第20期1566-1569,共4页National Medical Journal of China

摘　　要：目的探讨后腹腔镜老龄活体供肾。肾移植的安全性及临床效果。方法回顾性分析解放军第三。九医院2011年3月至2014年3月行后腹腔镜活体供肾。肾移植术的供者年龄i〉55岁的44例供者及对应受者（老龄供肾组）的临床资料，并以同期供者年龄〈55岁的79例供者及对应受者作为对照（中青年供肾组）。比较两组供、受者术后并发症，供者保留肾肾功能恢复情况及移植肾肾功能恢复情况。结果两组供者临床基线资料比较显示，老龄供肾组肾小球滤过率（GFR）较中青年组低（P=0．04）。123例供者均顺利完成后腹腔镜供肾切取，两组供、受者术后并发症差异均无统计学意义（P=0．60；P=1．00）。老龄供肾组供者术后3天平均血肌酐值明显高于中青年组供者[（115．8±22．3）比（102．5±16．3）μmol／L，P〈0．01]；相应的估计肾小球滤过率（eGFR）更低[（53．0±9．1）比（59．6±8．3）ml·min^-1·（1．73m^2）^-1，P〈0．01]；术后1周及半年两组血肌酐及eGFR值差异均无统计学意义（均P〉0．05）。老龄供肾组受者术后4例发生移植肾功能延迟恢复（DGF），3例发生急性排斥反应；中青年组受者8例发生DGF，5例发生急性排斥反应，两组比较差异均无统计学意义（均P=1．00）。术后1周及1、3、6、12个月eGFR，中青年供肾组受者均高于老龄供肾组受者，但差异均无统计学意义（均P〉0．05）。随访（27．8±12．6）个月，老龄供肾组受者1例肺部感染死亡；中青年供肾组受者2例肾失功能，两组受者肾存活率比较差异无统计学意义（P=0．95）。结论后腹腔镜活体供肾切取术对老龄供者安全可行。术前应仔细评估，术中仔细操作，术后严密监测跟踪随访，可获得满意的临床效果。Objective To evaluate the safety and effectiveness of retroperitoneoscopic donor nephrectomy in elderly donors for renal transplantation. Methods A retrospective analysis was conducted with 123 cases of retroperitoneoscopie living donor kidney transplantation in 309th Hospital of PLA from March 2011 to March 2014, including 44 elderly donors （age I〉 55 years） and 79 young to middle-aged donors （age 〈 55 years）. Comparisons were made in terms of postoperative complications in both donors and recipients, renal function recovery in the donors and function of graft in the recipients. Results The clinical baseline data of the two groups shows that glomerular filtration rate （GFR） of donors in the elderly donor group was lower than the young donor group （P = 0.04） . The 123 donors all underwent retroperitoneoscopic donor nephrectomy successfully. Postoperative complications in donors and recipients of both groups had no significant differences （ P = 0. 60 ; P = 1.00）. In the elderly donor group, the mean serum creatinine level of donors was significantly higher than that in the young donors group [ （ 115.8 ± 22. 3 ） vs （ 102. 5 ± 16. 3 ） ptmol/L, P 〈 0. 01 ] 3 days after operation; and estimated GFR （eGFR） was lower [ （53.0 ± 9. 1 ） vs（59.6 ± 8.3 ） ml· min^-1 . （ 1.73 m^2 ） ^- 1, P 〈 0. 01 ]. Serum creatinine and eGFR of the two groups showed no significant differences one week and six months after surgery （ all P 〉 0. 05 ）. Four recipients in the elderly donor group had delayed graft function （DGF）, 3 had acute rejection; 8 recipients in the young donor group had DGF, 5 had acute rejection; no statistically significant differences were observed between the 2 groups （ both P = 1.00）. Recipients＇ eGFR were higher in the young donor group than in the elderly donor group at 1 week, 1 month, 3 months, 6 months and 12 months after surgery,but with no statistically significant differences （ all P 〉 0. 05 ）. After （27. 8 ± 12. 6） months follow

关 键 词：肾移植 活体供者 腹腔镜检查 年龄组 

分 类 号：R699.2[医药卫生—泌尿科学]