活体肾移植血管重建69例临床分析

Vascular reconstruction in living donor kidney transplantation

目的介绍活体肾移植血管重建的临床经验。方法自2005年12月至2008年11月共行活体肾移植69例,供者手术均采用十一肋间小切口开放手术。58例单支肾动脉除2例外均采用肾动脉与髂外动脉端侧吻合重建血管,用4 mm打孔器作髂外动脉开口;6例副肾动脉分别采用原位(肾下极副肾动脉)或离体腹壁下动脉(肾上极副肾动脉)重建血管;3例双支肾动脉根据两支动脉口径不同采用不同方法重建血管;2例3支肾动脉采用受者离体髂内动脉重建血管。结扎多支肾静脉中较小的肾静脉只吻合其较大的主干,当两支肾静脉口径相近时,则将其整形为一个开口后吻合。结果所有血管吻合均一次完成,开放血流时吻合口均通畅;所有供者和受者术后均恢复顺利,受者未发生血管重建相关并发症;随访1个月～3年,供受者均存活,受者除1例血肌酐250～300μmol/L外,68例血肌酐维持在70～150μmol/L。结论该活体肾移植血管重建方式安全、实用、操作方便,多支供肾动脉及多支供肾静脉均能较好重建,移植肾功能良好。

Objective To study the clinic experience of vascular reconstruction in living donor kidney transplantation （LDKT） of a single center. Methods Sixty-nine cases of LDKT were performed using routine vascular reconstruction procedures established in our center from Dec. 2005 to Nov. 2008. Donor operations were performed using open surgery with small lumbar incision. Vascular punch （4 ram） was used to make anastomosis hole in external illiac artery. All the upper polar or lower polar accessory artery was reconstructed using the recipients＇ inferior epigastric artery or its graft （ n = 6）. In ease of double renal arteries there were three methods to reconstruct （ n = 3 ）. The internal illiac artery grafts of the recipients were used to reconstruct triple arteries of the renal grafts ex vivo （ n = 2）. In case of multiple renal veins, the smaller ones were simply ligated and reconstruction was performed when the two renal veins had the same size. Donor inferior veua cava patch （1-2 mm in width, right kidney） or adrenal vein （left kidney） was used to make wider venous anastomosis. Results All the anastomoses were perfomed successfully without repeating. The patency of the anastomoses was 100% at the reperfusion. Both donors and recipients recovered smoothly. No complication related to vascular reconstruction either of artery or of vein was observed in this study. The follow-up time was 1 to 36 months. All the recipients survived with creatine levels of 70-150 umol/L except one with 250-300 umol/L. Conclusion The routine vascular reconstruction procedures established is safe, effective and easy to performed. Either multiple arteries or multiple veins can be reconstructed successfully without increasing the vascular complication in LDKT.