婴儿双供肾成人肾移植的14例报告及手术技术改进  

Outcome of en bloc kidney transplantation from deceased infant donors to adult recipients and surgical consideration

作　　者：刘斌[1] 陈花 曾凡军[1] 杜潇潇[1] 郝晓军 王振兴 陈刚[1] 朱兰[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院器官移植研究所,教育部器官移植重点实验室,国家卫生计生委器官移植重点实验室,武汉430030 [2]山西省第二人民医院肾移植透析中心,太原030012

出　　处：《中华器官移植杂志》2017年第2期100-103,共4页Chinese Journal of Organ Transplantation

基　　金：卫生部行业基金科研专项（201302009）

摘　　要：目的 总结婴儿双供肾成人肾移植的临床效果和外科技术经验.方法 14例婴儿供者,年龄17d至8个月,体重2.5～8.6 kg,均为“中国二类”器官捐献供者.14例成人受者,平均年龄38岁（19～61岁）.根据血管重建方式的不同,受者可分为经典术式组（例1至例9）与简化术式组（例10至例14）.经典术式是将双供肾带有的腹部大血管一端封闭,另一端与受者的髂外动、静脉分别端侧吻合,或者与髂内动脉端端吻合;简化术式是将双供肾连带的腹部大血管后壁剪开,分别沿肾动、静脉开口修剪成血管袖片,再将其与受者的髂外动、静脉行端侧吻合.双侧供肾输尿管分别与膀胱吻合完成输尿管重建.经典术式组受者术后给予肝素抗凝治疗,简化术式组未使用抗凝药物.围手术期监测受者的尿常规和肾功能变化,采用彩色多普勒超声检查监测移植肾血流情况及体积变化.结果 经典术式组受者围手术期出现双肾动脉栓塞和单侧肾动脉栓塞各1例,术后16d因肺部感染死亡1例,以上3例不纳入长期随访;该组其余6例受者中,2例分别于术后11和4个月发生移植肾功能丧失而切除双移植肾,维持随访的4例与简化术式组5例受者的移植肾功能早期恢复,术后24周时血肌酐水平（81.7±27.4）μmol/L,估算肾小球滤过率（eGFR）为（86.5 ±22.2）ml·min-1·1.73 m^-2,简化术式组受者未发生外科并发症.结论 婴儿双供肾整块移植给成人受者的效果良好;采用经典术式者外科并发症多见,简化术式则有利于提高手术成功率,减少技术因素导致的移植肾功能丧失,值得临床推广.Objective To summarize the effect of en bloc kidney transplantation （EBKT） from cardiac deceased infant donors into adult recipients and to share a new simplified EBKT technique.Methods Fourteen dual kidneys from infant donors （9 males,and 5 females） were transplanted into adult recipients （3 males,and 11 females）.The donor ages ranged from 17 days to 8 months,and the recipient ages ranged from 19 years to 61 years.The recipients were categorized into 2 groups in terms of the microvascular surgical techniques.Case 1 to case 9 was given traditional techniques and case 10 to case 14 simplified techniques.In detail,the dual kidneys were recovered en bloc with the aorta and inferior vena cava.After splitting the rear wall of the donor aorta and inferior vena cava,suitable size of patches were made by cutting along the vascular openings of renal arteries and renal veins.We anastomosed the aorta patch to the external iliac artery in an end-to-side fashion.The donor inferior vena cava patch was anastomosed to the external iliac vein in an end-to-side fashion.The distal ends of ureters were implanted into the bladder separately.Results In traditional group,two cases underwent peri-operative graft loss because of renal artery thrombosis,and one patient died of pneumonia 16 days post-operation.During the follow-up period,graft loss was seen in 2 patients caused by irreversible drug-induced nephrotoxicity and donor-derived malignant tumor respectively.The mean serum creatinine level was 81.7 ± 27.4 μmol/L and eGFR level was 82.5 ± 22.2 mL/min/1.73 m^2 in the other EBKT recipients at 24th week post-operation.In simplified group,no vascular complications post-operation occurred.Conclusion En bloc infant kidneys could be transplanted into adult recipients successfully with excellent graft function and survival outcome while censored perioperative patient death and surgical failure.Instead of traditional EBKT technique,simplified EBKT technique could decrease the incidence of surgical vascular complications and s

关 键 词：婴儿 供者 双肾移植 整块移植 

分 类 号：R699.2[医药卫生—泌尿科学]