两种供体肾脏切取手术方法的比较研究

Comparative Study of Different Method of Donor Nephrectomy

目的比较供体肾脏两种切取手术方法的优劣，探讨供体肾切取的理想方法。方法我院从2001年4月-2005年10月共切取供体肾脏458只，回顾分析两种切取供体肾的方法。统计学分析和比较这两种方法切取肾脏的时间，肾脏热缺血时间，肾血管、肾、输尿管损伤率，急性肾小管坏死的发生率及供肾移植术后肾功能恢复情况等。结果“先取肾后灌注法”肾脏平均热缺血时间为5．63min，取肾手术时间平均为3．82min，肾血管、肾、输尿管损伤率4．21％，急性肾小管坏死发生率（ATN）发生率为4．00％，供肾移植手术后肾功能恢复时间平均6．51d。“先灌注后取肾法”肾脏平均热缺血时间为2．03min，取肾手术时间平均为6．62min，肾血管、肾、输尿管损伤率2．23％，ATN发生率2．14％，供肾移植术后肾功能恢复正常所需时间平均4．61d。结论原位灌注后再切取供肾的方法能最大限度地缩短热缺血时间；供肾灌注良好，尤其是对有多支动脉的供体肾脏能充分灌注；取肾操作从容，可以最大限度地避免肾脏的挤压伤以及输尿管、肾血管的损伤，保证供肾的质量，提高供肾的利用率以及肾移植的成功率。原位灌注后再切取供肾的方法在热缺血时间，移植肾功能恢复时间等方面明显优于先切取肾脏后灌注的取肾方法，是一种比较理想的供肾切取方法。

Objective To explore an ideal procurement technology for cadaveric donor nephrectomy. Methods Clinical data of 458 donors nephrectomy from April 2001 to Oct. 2005 were retrospected. both kidneys （HIT）, the Enbloc removal of both kidneys and enbloc removal with orthotropic cooling perfusion were adopted in different periods of time. Operation time （OT）, hot ischemia time damage rate （DR） of renal vascular/kidney/ureter, renal function of recovery time （RRT） and rate of renal tubular necrosis （ATN） were observed and compared between the two techniques. Results 112 cases were accomplished by enbloc removal and 224 kidneys were procured. 117 cases were accomplished by enbloc removal with orthotropic cooling perfusion and 234 kidneys were procured. HIT of the both techniques （enbloc removal and enbloc removal with orthotropic cooling perfusion） were（5.63 ± 1.4）min and（2.03 ±0. 7）min （ P 〈0. 01 ）, OT were（3.82 ± 1.2）min and（6.62±1. 8）min （P 〈0.05） respectively. DR were（4.21 ±0.8）% and（2.23 ±0.7）% （P 〈0.05）. ATN were 4. 00% and 2.14% （ P =0. 137）. RRT were（6.51 ±2.1）d and（4.61 ± 1.3）d （ P 〈 0.05 ）. Conclusion It suggested that enbloe removal with orthotropie cooling perfusion technique could shorten the hot isehemia time, ensure the quality of harvesting kidney and make full use of eadaverie organs. Meanwhile, this technique has great advantages of simple procedure,it was an ideal procurement of eadaverie donor kidney.