改进的套袖法吻合肾动脉建立大鼠原位肾移植模型

Renal transplantation in rats： revascularizatton of renal artery by the modified sleeve anastomosis

目的观察改进的套袖法吻合肾动脉用于大鼠肾移植的可行性。方法选择F344大鼠和Lewis大鼠分别作为肾移植的供、受者。切取供者左侧肾脏时，先剪断输尿管，然后阻断肾动、静脉水平上下的腹主动脉和下腔静脉，靠近下腔静脉剪断左肾静脉根部，经腹主动脉注入含肝素的4℃生理盐水对供。肾进行原位灌洗后，靠近腹主动脉剪断。肾动脉根部，取出供肾，放入4℃生理盐水中保存。切除受者左侧肾脏时，尽可能长的保留肾动、静脉以利于吻合。供肾植入时，采用改进的套袖法：用显微镊轻轻扩张供‘肾动脉后，协助显微持针器将针从供肾动脉血管外向血管内穿入，并从血管断端穿出第1针；接着穿入受者肾动脉断端，从受者肾动脉腔内向腔外穿出第2针；然后再从供肾动脉腔内、靠近第1针进针点处向腔外穿出，并与第1针的另外一端打结，此时受者的肾动脉已套入供肾动脉内；将供肾动脉边缘与受者肾动脉外膜固定2针，2针呈180度对角。供、受者的肾静脉及输尿管均行端端吻合。术后5d内，若受者死亡，则认为手术失败。结果共行肾移植20次，整个手术耗时70-90min，供肾热缺血时间为4～9s，冷缺血时间为30-40min，肾动脉吻合用时（4．6±0．6）min，肾静脉吻合用时（11．8±1．2）min，输尿管吻合用时（12．2±1．4）min。术后5d内，受者不明原因死亡1只，存活19只，手术成功率为95％。结论采用改进的套袖法吻合肾动脉具有便捷、易于掌握、可靠及实用等优点，大鼠肾移植的成功率较高。

Objective To improve arterial anastomosis method for renal transplantation model in rats. Methods Male Fisher and Lewis rats were used as kidney donors and recipients respectively, and left kidneys were harvested in situ. Revaseularizations of renal artery were fashioned end-to-end by the modified sleeve anastomosis. The renal artery was placed in the orthotopic position and sutures were inserted in order to place the feeding vessel into the receiving vessel. One invaginating suture was placed starting outside the donor＇s renal artery wall, approximately 2 mm from the free edge, then passing through the free edge of the recipient renal artery, and lastly passing again through the donor＇s renal artery wall out alongside the point of entry, The sutures were tied so that the recipient renal artery was drawn inside the donor＇s renal artery, Thereafter, one external stitch was placed opposite to the invaginating suture passing through the overlapped free distal edge and the adventitia of the recipient renal artery, and the suture the opposite side using the same technique. The renal veins and ureters were anastomosed using end-to-end interrupted suture technique, Results Twenty cases of rat renal transplantation were performed. The transplantation procedures took totally between 70-90 min. The time for arterial anastomosis was approximately （4. 6 ± 0. 6） min, the mean time for anastomosis of the renal vein in 20 grafts was （11. 8± 1.2） rain,and ureter was （12. 2 ± 1.4） min. The successful rate of the model was 95 % at the 5th day. Conclusion New end to-end technique which incorporates a modification of the sleeve anastomosis is the safest way to perform a revascularization of renal artery. This suggests that the technique is feasible and reliable,