应用肾静脉袖套式血管吻合技术建立小鼠原位肾移植模型

Orthotopic kidney transplantation in mice： technique using cuff for renal vein anastomosis

目的观察与比较采用肾静脉袖套式血管吻合技术建立的小鼠原位肾移植模型与传统小鼠肾移植模型技术的优缺点。方法取C57BL／6小鼠136只，采用随机数字表法将小鼠分为供鼠和受鼠，并建立小鼠原位肾移植模型68例，其中20例小鼠原位肾移植模型采用传统技术（传统组），48例采用新式肾静脉袖套式吻合技术（袖套组），取袖套组中18例受鼠，仅观察术后10周的存活情况。传统小鼠肾移植技术需要在阻断下腔静脉和主动脉的同时进行肾动脉和静脉吻合。采用肾静脉袖套式血管吻合技术将静脉导管套在供肾静脉外，以肾静脉的静脉导管为支架，向外翻折并结扎固定。在受鼠手术时将供肾的肾静脉袖套直接插入到受鼠肾静脉。结果袖套组肾移植术中肾静脉的吻合时间为4min，较传统组的9min显著缩短，两组比较，差异有统计学意义（P〈0．01）；而两组间动脉吻合时间的差异无统计学意义（P〉0．05）。传统组受鼠的手术成功率为75％，显著低于袖套组的93．3％（P〈0．01）。肾移植术后2h，传统组受鼠的尿蛋白水平为20g／L，明显高于袖套组的3g／L，两组比较，差异有统计学意义（P〈0．05）。袖套组18只受鼠术后10周存活率为88．9％（16／18），其血肌酐在肾移植后轻度增高，在10周的观察期间均保持稳定。结论肾静脉袖套式吻合技术简化了微血管吻合，为建立稳定的小鼠。肾移植模型奠定了基础。

Objective To compare the ＂cuffed＂ renal vein technique and the classical techniques in kidney transplantation. Method The classical techniques of mouse renal transplantation required clamping both vena cava and aorta simultaneously and carried out suture anastomoses of the renal artery and vein in a heterotopic position. In our laboratory, we have successfully developed mouse orthotopic kidney transplantation for the first time, using a rapid ＂cuffed＂ renal vein technique for vessel anastomosis, wherein the donor＇s renal vein was inserted through an intravenous catheter, folded back and tied. During grafting, the cuffed renal vein was directly inserted into the recipient＇s renal vein without the need for clamping vena cava and suturing renal vein. Result This technique allowed for the exact transplantation of the kidney into the original position, compared to the classical technique, and had significantly shortened the clamping time due to a quicker and more precise anastomosis of renal vein as described. The renal vein anastomoses time was dramatically shortened in cuffed renal vein technique （4 rain） as compared with the classical technique （9 rain, P〈0.001 ）. This also allowed for a quicker recovery of the lower extremity activity, reduction in myoglobinuria with resultant kidney graft survival of 88. 9%. Conclusion The cuffed renal vein technique simplifies microvascular anastomoses and affords important additional benefits.