婴儿双供肾成人肾移植的改良简化术式四例

Modified en-bloc kidney transplantation from deceased infant donor to adult recipients:a report of 4 cases

目的总结婴儿双供肾成人肾移植的改良简化术式的手术方式及临床效果。方法总结山西省第二人民医院肾移植透析中心2017年1月至2019年9月采用改良简化术式进行的4例婴儿双供肾成人肾移植资料。4例均为心死亡供者,男性3例,女性1例,年龄(54±22.69)d,体重为(5.6±0.79)kg。受者中男性1例,女性3例,年龄(41.5±5.97)岁,体重(45±3.56)kg。俢肾过程中将双侧供肾缝合固定,使双肾位置相对固定,行供肾腹主动脉瓣-受者髂外动脉、供肾下腔静脉瓣-受者髂外静脉端侧吻合,以降低手术难度、避免血流动力学紊乱。结果4例手术过程均顺利,供肾修整平均历时20 min,移植手术平均历时68.75 min。未出现血管及泌尿系统并发症,随访12个月移植肾功能恢复良好,受者及移植肾远期存活满意。结论改良简化婴儿双供肾成人整块肾移植优化了手术方式,操作简便且降低血管并发症,提高手术成功率,值得在临床实践中推广应用。

Objective To introduce a newly modified surgical approach and explore the clinical efficacy of en bloc kidney transplantation from deceased infant donors to adults.Methods Four cases of en bloc kidney transplantation from deceased infant donor to adult were performed with a new modified surgical approach in renal transplantation and dialysis center of the Second People's Hospital of Shanxi Province from January 2017 to September 2019.All 4 cases were cardiac death donors.There were 3 males and 1 female donors,aged(54±22.69)d and weighing(5.6±0.79)kg.There were 1 male and 3 female recipients,aged(41.5±5.97)years and weighing(45±3.56)kg.For lowering operative difficulties and preventing hemodynamic disturbances,bilateral kidneys were sutured and fixed during trimming.Then end-to-side anastomosis was performed between donor kidney abdominal aortic valve and recipient external iliac artery and between donor renal inferior vena cava valve and recipient external iliac vein.Results All operations were successful without vascular or urinary complication.The average duration of donor kidney repair was 20 min and the average duration of transplantation 68.75 min.The functions of transplanted kidney recovered well during a follow-up period of 12 months.The long-term survivals of recipient and transplanted kidney were satisfactory.Conclusions The newly modified surgical approach of en bloc kidney transplantation from deceased infant donor to adult has optimized operative handling.With a higher success rate,vascular complications are lowered.A wider popularization is recommended.