右肾静脉延长在肾移植中的应用

Lengthening the right renal vein by the vena cava for kidney graft

观察右侧供肾静脉延长在肾移植中的应用效果。选择1984-08/2004-05在北华大学附属医院泌尿外科及吉林医药学院附属医院泌尿外科采用腔静脉延长右肾静脉的肾移植患者96例,均为男性尸体供肾,患者均签署知情同意书。在供肾切取时,留取足够长度的下腔静脉瓣。在供肾修整时,根据所测量出右肾静脉的长度,利用供体腔静脉适当延长右侧供肾静脉,与受者的髂外静脉吻合。采用彩色多普勒超声检查移植肾静脉直径及血流速度,观察有无出血、血栓、狭窄等并发症。术后定期随访。96只右侧供肾静脉长度为1.7～3.8cm,平均长度3.2cm。静脉延长后长度为5.5～7.0cm,平均6.0cm。手术中静脉吻合均顺利完成。96例肾移植患者术后随访6～12个月,其中6～9个月31例,10～12个月65例。移植肾静脉直径及血流速度无异常改变,未发生与静脉延长相关的并发症。利用供体腔静脉延长右侧供肾静脉可使移植术中血管吻合更加容易,损伤小,技术简单而且没有血管并发症。

Abstract： To observe the effect of lengthening the fight renal vein of the kidney graft during the operation of renal transplantation, 96 cases of patients underwent kidney transplantation through lengthening the vena cava were selected from Department of Urinary Surgery, Affiliated Hospital of Beihua University and Department of Urinary Surgery, Affiliated Hospital of Jilin Medical College between August 1984 and May 2004. The kidney was from male corpse donors, and the informed consent was obtained. The caval valve with adequate length was reserved when harvesting the kidney, and during trimming the kidney grafts, the fight renal vein was lengthened according to the length of it by the vena cava of the donor to make it coincide with the external lilac vein of the acceptor. The renal vein diameter and blood flow rate of kidney graft were detected by color Doppler ultrasonography to identify if there was haemorrhage, thrombus, stenosis or other complications. All patients were followed up postoperatively for 6-12 months including 31 cases for 6-9 months and 65 cases for 10-12 months. The lengths of 96 fight renal veins ranged from 1.7 cm to 3.8 cm （mean 3.2 cm）. After vessel reconstruction, it was lengthened between 5.5 cm and 7.0 cm （mean 6.0 cm）. The venous anastomosis was successfully performed in all the 96 cases. No abnormal change was found in the venous diameter or blood flow rate, neither were the complications associated with the vein lengthening. Lengthening the fight renal vein by the vena cava of donor could make the venous anastomosis easier with the advantages of less injury, easy to perform and no complications.