肾移植无心跳供者供肾1141次的处理

The treatment of 1 141 cases times NHBCD kidney grafts

目的：探讨整块取肾法与分侧取肾法、高渗枸橼酸钠腺嘌呤肾保存液（ＨＣＡ）与乳酸林格液（ＬＡＬ）的优劣，研究缺血时间的长短对移植肾原发性无功能（ＰＮＦ）发生率的影响。方法：将１１４１次采用无心跳供者供肾所做同种异体肾移植患者的临床资料作回顾性分析，按不同的取肾方法、不同的保存方法、不同的缺血时间分组别进行比较，观察其统计学上的差异。结果：（１）整块取肾的热缺血时间与分侧取肾法相似，但进行肾移植术时前者更容易；（２）ＬＡＬ组的术后见尿时间为（２５．４８±６．５３）ｍｉｎ，ＨＣＡ组为（１５．６３±１０．００）ｍｉｎ（Ｐ＜０．０１），术后肾功能恢复正常所需时间前者为（８．６５±３．３９）ｄ，后者为（６．６６±２．７３）ｄ（Ｐ＜０．０５），ＰＮＦ的发生率分别为１１．１１％，２．１４％（Ｐ＜０．０１）；（３）ＨＣＡ组中，当总缺血时间分别为≤１０，２０，３０，４０，５０和＞５０ｈ时，其ＰＮＦ的发生率分别为０％，１．８３％，１．２３％，６．２５％，５．８８％和９．５２％。结论：（１）整块取肾法优于分侧取肾法；（２）ＨＣＡ对移植肾的保存效果好于ＬＡＬ；（３）ＨＣＡ组中，总缺血时间的延长将明显延缓肾移植术后见尿时间、肾功能的恢复?

Objective: To understand the superiority of the kidney procurement method en bloc to the side by side method, and that of high osmolar citric natrium adenine (HCA) solution to lactic acid linger’s (LAL)solution, and to clarify the effect of ischemic time on primary non function (PNF) incidence in grafted kidney. Methods: The clinical data of 1 141 non heart beating cadaver donor (NHBCD) grafts were analysed retrospectively according to different methods of kidney procurement, different preservative methods and different ischemic time. Results: (1) Hot ischemia time (HIT) of kidney procurement en bloc was similar to that of side by side, but the former’s operation was easier than the laters; (2) The time of passing urine after revascularization was (25.48±6.53) min in the LAL group and (15.63±10.00) min in the HCA group, respectively (P< 0.01 ), renal function normalization time was (8.65±3.39) d and (6.66± 2. 73) d, respectively (P<0.05), and PNF incidences were 11.11% and 2.14%, respectively(P< 0.01 ). (3) As the total ischmia time with HCA solution preservation was ≤10, 20, 30, 40, 50 and >50 h, the PNF incidences were 0%, 1.83%, 1.23%, 6.25%, 5.88% and 9.52%, respectively. Conclusion: (1) Kidney procurement en bloc is better than that of side by side; (2)The preservative effect of HCA solution is significantly better than that of LAL solution ; (3) Preservative prolongaton would increase the incidence of PNF;(4)The application of HCA solution eases the clinical procession of Tx, and thus provides a basis for massive kidney transplantation.