同种异体肾移植手术难度的影响因素分析  

Influencing factors of difficulty in allogeneic kidney transplantation

作　　者：吕竟成 郭宇文[1] 张磊[1] 王志鹏[1] 张健[1] 朱一辰[1] Lyu Jingcheng;Guo Yuwen;Zhang Lei;Wang Zhipeng;Zhang Jian;Zhu Yichen(Department of Urology,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院泌尿外科,北京100050

出　　处：《国际外科学杂志》2022年第10期663-668,共6页International Journal of Surgery

摘　　要：目的探究在成人同种异体肾移植手术中,影响手术难度的受者及供肾相关因素。方法采用回顾性研究方法,选取2020年1月—2021年12月于首都医科大学附属北京友谊医院诊断为终末期肾病并行同种异体肾移植手术的患者183例。以肾移植手术时间作为评价手术难度的指标,同时收集可能影响手术难度的相关临床指标,包括受者年龄、体重指数、移植前透析方式、血脂水平、皮下脂肪厚度、血管吻合方式及供肾长度、供肾体积等,采用Pearson、Spearman相关性检验评价上述指标与手术难度之间的相关性。结果在受者方面,高体重指数(P=0.006)、移植前腹膜透析(P=0.035)、血清胆固醇(P=0.016)及甘油三酯(P<0.001)水平较高、皮下脂肪较厚(P=0.032)及待吻合血管存在钙化(P<0.001)均会导致肾移植手术难度增加,进而延长手术时间;在供肾方面,移植肾长度(P<0.001)及体积(P<0.001)越大,肾移植手术时间越长。同时,移植肾与受者多支血管复杂吻合的手术难度相比单支髂内及单支髂外动脉吻合均更高(P=0.005),手术时间更长。结论受者移植前肥胖程度、透析方式、血脂水平、供肾大小及血管吻合方式均是影响肾移植手术难度的因素。对于具有以上危险因素的患者,肾移植手术难度可能较高、时间相对较长,临床可选择更具肾移植手术经验的医师进行手术,以缩短手术时间,甚至降低术后并发症。Objective To explore the factors related to the difficulty of adult allogeneic renal transplantation.Methods Used retrospective study method,a total of 183 patients who were diagnosed with end-stage renal disease and underwent allogeneic kidney transplantation in Beijing Friendship Hospital,Capital Medical University from January 2020 to December 2021 were included in this study.With kidney transplant operation time as the evaluation criteria of operation difficulty,relevant clinical indicators that may affect the difficulty of surgery were collected,including recipient age,body mass index,pretransplant dialysis mode,blood lipid level,subcutaneous fat thickness,vascular anastomosis mode,donor kidney length,donor kidney volume,etc.Pearson,Spearman correlation test were used to analyze the correlation between the above indexes and surgical difficulty.Results In terms of recipients,higher body mass index(P=0.006),peritoneal dialysis before transplantation(P=0.035),higher serum cholesterol(P=0.016)and triglyceride(P<0.001),thicker subcutaneous fat(P=0.032)and calcification of the vessels(P<0.001)all lead to increase the difficulty of kidney transplantation,and also prolong the operation time;in terms of kidney donors,the longer and larger of transplanted kidney length(P<0.001)and volume(P<0.001),the longer operation time will be cost.Meanwhile,the anastomosis of complex multi-vessel between kidney transplantation and recipient was more difficult than single internal iliac artery and single external iliac artery anastomosis(P=0.005),and the operation time was also longer.Conclusions The degree of obesity before transplantation,dialysis mode,blood lipid level,donor kidney size and vascular anastomosis mode were all factors affecting the difficulty of kidney transplantation.For patients with those above risk factors,the operation may be difficult and the surgical time can be much longer.Physicians with more experience in kidney transplantation can be selected to shorten the operation time,even reduce complications after

关 键 词：肾移植 因素分析 统计学 肾透析 手术难度 肥胖 血管吻合 

分 类 号：R699.2[医药卫生—泌尿科学]