腹腔镜活体供肾切取术中供肾穿刺活检的应用价值及安全性分析  

Analysis of the application value and safety of donor renal biopsy during laparoscopic living donor nephrectomy

作　　者：丁光璞 林俊[1] 朱一辰[1] 张健[1] Ding Guangpu;Lin Jun;Zhu Yichen;Zhang Jian(Department of Urology,Beijing Friendship Hospital,Capital Medical University,Institute of Urology,Beijing Municipal Health Commission,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,北京市卫生健康委员会泌尿外科研究所,北京100050

出　　处：《国际外科学杂志》2024年第10期671-676,I0004,共7页International Journal of Surgery

摘　　要：目的探讨腹腔镜活体供肾切取术中供肾穿刺活检的应用价值及安全性。方法回顾性分析2023年1—12月于首都医科大学附属北京友谊医院行活体肾移植的45对供受者的临床资料,采用Remuzzi评分对供肾穿刺病理进行评估。根据供者年龄及供肾穿刺病理Remuzzi评分对供受者进行分组,对比不同组间供者的临床资料、病理资料及移植肾功能等差异。采用Shapiro-Wilk检验判断数据是否满足正态分布。正态分布的计量资料以均数±标准差(±s)表示;非正态分布的计量资料以中位数(四分位间距)[M(Q_(1),Q_(3))]表示,组间比较采用Mann-WhitneyU检验。计数资料以例数和百分比[例(%)]表示,组间比较采用χ^(2)检验或Fisher确切概率法。结果1例受者术后出现动静脉瘘,其余活体肾移植供者、受者均未发生穿刺相关严重并发症。45例供肾穿刺病理中,36例(80.0%)供肾穿刺病理肾小球数量≥20个。供肾穿刺病理高Remuzzi评分(≥4分)组20例(44.4%,20/45),低Remuzzi评分(≤3分)组25例(55.6%,25/45)。17例(37.8%,17/45)供肾穿刺病理存在IgA沉积,1例(2.2%,1/45)供肾穿刺病理为IgA肾病。高Remuzzi评分组与低Remuzzi评分组在受者术后半年估算肾小球滤过率(eGFR)方面,差异无统计学意义(P>0.05)。6例(13.3%,6/45)高龄组(年龄≥60岁)供肾与39例(86.7%,39/45)低龄组(年龄<60岁)供肾在供肾穿刺病理Remuzzi评分、IgA沉积、IgA肾病、供者出院时eGFR及受者术后半年eGFR方面,差异均无统计学意义(P>0.05)。结论腹腔镜活体供肾切取术中供肾穿刺活检是一种安全、有效的供肾评估方式。异常供肾穿刺结果与供者、受者预后的关系目前尚不明确,但是异常供肾穿刺活检的供者及受者需要术后密切随访。ObjectiveTo investigate the application value and safety of donor renal biopsy during laparoscopic living donor nephrectomy.MethodsThe clinical data of 45 pairs of living donor and recipients who underwent living kidney transplantation in Beijing Friendship Hospital,Capital Medical University from January 2023 to December 2023 were retrospectively analyzed.Remuzzi score was used to evaluate the renal biopsy pathology of the donor kidney.Recipients and donors were divided in different groups by donor age and Remuzzi score of the donor kidney biopsy.The clinical data,pathological data and renal function of the donors in different groups were compared.Shapiro-Wilk test was used to determine whether the data satisfied the normal distribution.The measurement data with normal distribution were expressed as mean±standard deviation(±s).The measurement data with non-normal distribution were expressed as median(interquartile range)[M(Q 1,Q 3)],and comparison between groups was analyzed using the Mann-Whitney U test.Count data were expressed as the number of cases and percentage,and the Chi-square test or Fisher exact probability method was used for comparison between groups.ResultsOne recipient suffered from postoperative arteriovenous fistula,and the other living kidney transplant donors and recipients had no serious complications related to biopsy.Among the 45 cases of donor renal biopsy pathology,glomerular number was≥20 in 36 cases(80.0%).There were 20 cases(44.4%,20/45)in the high Remuzzi score group(≥4 points)and 25 cases(55.6%,25/45)in the low Remuzzi score group(≤3 points).There were 17 cases(37.8%,17/45)with IgA deposition and 1 case(2.2%,1/45)with IgA nephropathy.There was no significant difference between the high Remuzzi score group and the low Remuzzi score group in terms of estimating glomerular filtration rate(eGFR)half year after surgery(P>0.05).6 cases(13.3%,6/45)in the elderly group(age≥60 years)and 39 cases(86.7%,39/45)in the young group(age<60 years)had no significant difference in Remuzzi sco

关 键 词：肾移植 活体供者 肾切除术 活组织检查 

分 类 号：R699.2[医药卫生—泌尿科学]