幼猪同种异体异位肾移植技术探讨

The Surgery Technique of Living Allograft Heterotopic Kidney Transplantation in Pig

目的研究大动物活体肾移植的外科技术。方法应用氯胺胴、安定静脉麻醉,游离供体左肾动、静脉及输尿管,切取左肾,离体灌注后备用。游离受体腹主动脉、下腔静脉。将供肾动、静脉分别与受体腹主动脉、下腔静脉作端侧吻合,供体输尿管与受体膀胱吻合后单J管从腹壁引出作外引流。结果22头幼猪共完成15例次活体肾移植手术。移植肾冷缺血时间为35～70min,血管吻合时间为28～52min。手术中死亡3例,其中2例(供、受体各1例)死于麻醉过深,1例死于肺动脉血栓栓塞。出现输尿管膀胱吻合口尿瘘1例,输尿管狭窄1例。结论娴熟的外科技术和良好的人员配合是大动物活体肾移植成功的基础,是减少术后并发症的关键。

Objective To research the surgery technique of living allograft heterotopic kidney transplantation in pig.Methods After the induction of anesthesia, the left renal artery, vein and ureter were dissected and the nephretomy was then done, the kidney was perfused and stored in 4oc perfusion solution for transplantation.Mobilized the aorta from the vena cava of the recipient, the end -to- side anastomoses of the renal artery,vein to the aorta, inferior vena cava were performed. On completion of the ureteroneocystostomy, a “J” type was placed through low abdominal wall into the bladder and was taken as a temporary ureteral stent.Results Fifteen proceders of living allograft heterotopic kidney transplantation were finished in 22 pigs. The cold storage was 35～70 minutes, the time of vascular anastomoses was 28～52 minutes. Three pigs died in the operation,2 died of over anesthesia and another one died of arterial thrombosis. Urine leak from ureter-bladder anastomosis happened in 1 case, ureteral stenosis happened in another case. Conclusion Skillful surgical technique and excellent management is critical to successful results of kidney transplantation in big animals sand a significant reduction of complications.