显微吻合技术在严重血管毁损肝、肾移植中的应用:4例报告

Clinical application of microsurgery in vascular reconstruction of severely injured donor liver and kidney: A 4-case report

背景:肝、肾移植中,供者肝、肾切取和修复手术中可引起多种类型的肝、肾血管的损伤。同时在术中的分离、牵拉和解剖过程中容易造成损伤,影响供肝和供肾的质量。目前如何修复和处理供者肝、肾血管损伤,以提高供体器官的利用率还是临床难题。目的:探讨肝、肾移植供体严重血管毁损后进行显微血管重建的价值。方法:利用发生供体血管严重损伤的3例肝移植和1例肾移植供体,应用显微血管重建技术,对严重毁损的供肝、肾的重要移植血管进行重建,采用常规移植方法完成肝、肾移植,观察疗效。结果与结论:血管重建后移植物功能和血运良好,肝、肾移植患者术中尿管即引出清凉淡黄色尿液,术后每天尿量15002500mL,尿色清,颜色淡黄。肝移植患者术后血胆红素正常,引流管内液体胆红素定性未检出胆红素。术后4例患者均顺利恢复出院。在1.3～2年的随访时间内,4例患者均健康存活,未出现任何并发症。在各种原因造成的肝、肾供体血管严重毁损的情况下,可以利用精细的显微血管重建技术挽救血管严重毁损的供肝、肾,以达到较好的临床疗效。

BACKGROUND： In liver and kidney transplantation, donor liver and kidney acquisition and restoration can cause various liver and kidney vessel injuries. Moreover, the separation, drag and dissection may affect liver and renal donor quality. It is difficult to improve donor organ application by repairing liver and kidney vessel injuries. OBJECTIVE： To investigate the value of microsurgical vascular reconstruction in injured donor liver and kidney. METHODS： Hilar vessels were severely injured in 3 liver grafts and 1 kidney graft. Microsurgery was used for vascular reconstruction for arteries and veins of the grafts, followed by conventional procedure of transplantation. Clinical outcomes were analyzed. RESULTS AND CONCLUSION： All three liver grafts and one kidney graft were successfully rescued. Bile outputs were seen after reperfusion in all the three liver transplant recipients and urine output was also well in the kidney recipient. The urine volume was 1 500-2 500 mL per day. All 4 cases recovered and discharged in time. During 1.3 to 2 year’s follow up, all 4 cases survived with good graft function, with no complications. Microsurgical vascular reconstruction can be successfully applied for severely vascular injured liver and kidney graft. This might provide comparable good functional graft.