供体肝肾联合快速获取方法的改进及临床研究(附117例报告)

Modified techniques for combined liver and kidney graft rapid harvesting:a report of 117 cases

目的探讨供体肝肾联合快速获取方法的改进。方法分析2004年1月至2006年8月共117例肝肾联合快速切取的临床资料,观察移植术后1周的肝功能和凝血功能情况。快速切取技术采用原位腹主动脉、脾静脉灌注附加颈静脉、下腔静脉引流。采用4℃UW液和高渗枸橼酸盐腺嘌呤溶液(HCA液)灌注和保存。结果供体热缺血时间平均为2.7min,冷缺血时间平均为7h30min,切取时间平均为16.2min。肝移植术后1周的肝功能和凝血功能恢复良好,无原发性移植肝无功能的发生。联合获取方式改进后与原方法比较,γ-谷氨酰转肽酶、谷丙转氨酶、谷草转氨酶、直接胆红素、纤维蛋白原、凝血酶时间的差异均有统计学意义(P<0.05)。结论本方法简便、有效、可靠,所获取供肝的质量良好,适于供体肝肾联合快速获取。

Objective To improve the techniques for combined liver and kidney graft rapid harvesting. Methods The clinical data of 117 cases from Jan 2004 to Aug 2006 was analyzed. The liver function and blood coagulation one week after liver transplantation were observed. The techniques for rapid graft harvesting included in situ perfusion through abdominal aorta and splenic vein, plus drainage through jugular vein and inferior vena cava. UW solution and hypertonic citrate adenine solution （HCA） at 4℃ were used for organ perfusion and preservation in all cases. Results The average warm ischemia time of graft was 2.7 minutes, and the cold ischemia time was 7.5 hours. The average time of organ harvesting was 16.2 minutes. The liver function and blood coagulation mostly reached normal range one week after liver transplantation. There was no primary nonfunction in all liver grafts. There were marked differences in 7-GT, ALT, AST, DB, Fb and TT between the groups using improved method and group using original method （P〈0.05）. Conclusions It is suggested that the modified techniques are simple, efficient and safe to improve the quality of cadaveric organs, therefore more suitable for combined liver and kidney graft rapid harvesting.