降落伞缝合技术在活体肾移植变异供肾动脉吻合中的应用

Application of parachute suture technique in variant donor renal artery anastomosis of living-donor renal transplantation

目的探讨降落伞缝合技术在存在肾动脉变异的活体肾移植动脉吻合中的效果及优势。方法回顾性选取2020年1月—2022年11月于首都医科大学附属北京友谊医院泌尿中心接受活体亲属肾移植的供受者共79对,选择临床资料完整且存在多支供肾动脉变异的病例共11对,根据动脉吻合技术的不同将其分为试验组和对照组,试验组采用降落伞缝合技术,对照组采用传统2点或3点固定技术。其中试验组5对,对照组6对。收集两组供受者的一般资料、供肾情况、动脉重建方式、手术相关情况、受者恢复情况等资料。计量资料以均数±标准差(x±s)表示,组间比较采用Student-t检验;计数资料组间比较采用χ^(2)检验或Fisher确切概率法。结果试验组和对照组均为左侧供肾。两组供受者年龄、性别、体重指数、供肾估算肾小球滤过率比较,差异均无统计学意义(P>0.05)。试验组平均肾动脉2.2支,对照组平均肾动脉2.0支。试验组和对照组肾移植手术时间分别为(152.0±23.9)、(148.3±24.0)min,估计出血量分别为(90.0±41.8)、(91.7±58.5)mL,动脉吻合时间分别为(21.0±5.4)、(20.8±4.7)min,差异均无统计学意义(P>0.05)。动脉吻合结束后,试验组未进行补针或二次吻合,对照组共有3例进行了补针或二次吻合,差异具有统计学意义(P=0.002)。两组受者术后肾功能恢复、肾动脉相关并发症比较,差异均无统计学意义(P>0.05)。结论降落伞缝合技术可以在动脉管腔较细的情况下更准确地达到血管壁对层外翻缝合的目的,且不会明显延长手术时间,可能在肾动脉变异的活体肾移植中具有较好的应用价值。

Objective To investigate the effects and advantages of parachute technique in arterial anastomosis of living-donor renal transplantation with anatomical variations of renal artery.Methods A total of 79 pairs of donors and recipients who received living-donor renal transplantation at the Department of Urology,Beijing Friendship Hospital,Capital Medical University from January 2020 to November 2022 were retrospectively collected.11 pairs with completeness data and multiple donor renal arteries were selected.According to the different techniques,the cases using parachute technique were classified as experimental group and other cases as control group using traditional two-three-point fixation technique.There were 5 pairs in the experimental group and 6 pairs in the control group.The medical records of the two groups were collected,containing general data,the state of donated kidney,the arterial reonstruction method,the condition of perioperation and recovery of recipients.Measurement data were expressed as mean±standard deviation(x±s).Student-t test was used for inter-group comparison.The Chi-square test or Fisher exact probability method were used to compare the count data of groups.Results The donations of experimental group and control group were left-sided kidney.There were no statistical difference in age,gender,body mass index and estimated glomerular filtration rate of donors and recipients.The average number of renal arteries in the experimental group was 2.2,and that in the control group was 2.0.There were no statistical difference between the two groups in the mean time of transplantation surgery[(152.0±23.9)min vs(148.3±24.0)min],estimated blood loss[(90.0±41.8)mL vs(91.7±58.5)mL]and mean arterial anastomosis time[(21.0±5.4)min vs(20.8±4.7)min].At the end of arterial anastomosis,no case in the experimental group need acupuncture or secondary anastomosis,while the control group had 3 cases,the difference was statistically significant(P=0.002).There was no statistical difference in the recovery of renal function and complications related to renal arteries between the two groups(P>0.05).Conclusions Parachute suture technique can more accurately achieve the purpose of layer-to-layer eversion suture of vascular wall under the condition of narrow arterial lumen,and will not significantly prolong the operation time.It may have a good application value in living kidney transplantation with renal artery variation.