短血管活体亲属供肾肾移植术22例报告

Living related donor kidney with short vessels transplantation:clinical study of 22 cases

目的探讨提高短血管活体亲属供肾肾移植术成功率的方法。方法取活体亲属供肾移植患者22例,左侧供肾16例,右侧6例。取供肾时仅获取肾动、静脉约2cm。肾移植术中充分游离受体髂外动脉、静脉,将供肾动、静脉与髂外动、静脉端侧吻合;操作空间仍狭小影响血管吻合除去带碎冰的肾袋,应用冰盐水持续冲洗移植肾保持低温。结果取肾术手术时间(180±30)min,供者术后血肌酐均较术前增高,6～10d降至正常范围,平均住院(7±3)d。肾移植术手术时间(160±25)min。移植肾功能恢复正常时间3～15d,平均住院(17±4)d。复查血管超声,未出现肾动、静脉血栓或髂、股静脉血栓等并发症。无急性肾小管坏死出现。结论短血管供肾行肾移植术时充分游离受体髂血管和去除肾袋应用冰盐水持续冲洗移植肾保持低温方法可提高肾移植术的成功率,且较为安全。

Objective To investigate the methods for increasing the success rate of living related donor kidney with short vessels transplantation. Methods Twenty-two cases of living related donor were ehosen, in which 16 specimens of kidney from left side and 6 from right side were acquired. The length of renal arteries and veins were about 2 era. During the kidney transplantation, the external iliae artery and vein of acceptor were dissociated fully and anastomosed with the artery and vein of the donor kidneys. If the operation space was still narrow and influencing the anastomosis of the blood vessel, the transplant kidney could be flushed continually with ice saline to maintain low temperature. Results The surgery time for taking the kidney was （ 180± 30） rains, the blood creatinine of the donors increased after the operation and falls to the normal range in 6 - 10ds, the average hospital stay was（7 ±3）ds. The surgery time for kidney transplantation was （ 160 ± 25 ）rains, the time for the transplant kidney function restored to normal was 3 -15ds, the average hospital stay was （ 17± 4 ） ds. Reexamination of vascular ultrasound showed that there were no thrombus appeared in the kidney artery and vein , or the iliac vein and femoral vein. No acute kidney tubular necrosis appeared. Conclusion It can improve the success rate of Living related donor kidney with short vessels transplantation to dissociate the external iliac artery and vein sufficiently and flush the kidney continuously with ice saline instead of kidney bag, and also is safe.