原位灌洗联合快速切取腹腔器官的临床应用(附56例报告)

Improvement of surgical technique for combined liver and kidney harvesting in clinical practice

关键词:  器官切取  肝移植  肾移植

Key words:  donor harvest  liver transplantation  kidney transplantation

摘要:

［目的］ 探讨原位灌洗多器官联合快速切取的改进技术。［方法］沿腹主动脉插管灌注HC-A液，经肠系膜上静脉外科干向门静脉插管灌注UW液，取56例供体。［结果］ 应用该技术共获取肝脏56个，肾脏112个。热缺血时间平均为（3.0±1.5）min，肝、肾切取时间平均为（18±5.0）min。同时行2例胰肾联合移植,与心胸外科合作完成心脏切取6例、肺脏1例。进行的移植手术未出现肝脏、肾脏的灌注不良及移植物原发无功能。［结论］ 改进的原位灌洗多器官联合快速切取的技术方法的优点为保证器官充分灌注、减少污染、保护变异动脉、解剖固定,入路简便, 减少热缺血时间、节约费用。

Abstract:

［Objective］To explore and discuss the improvement of the surgical techniques of “En bloc” harvesting liver and kidney graft from cadaveric donor. ［Methods］ The technique of combined liver and kidney harvesting was refined with liver perfusion via the surgical trunk of the superior mesentery vein (SMV) and the abdominal artery, the technique was used for 56 times of harvesting. ［Results］ In 56 times of harvesting, the procedure of organ harvesting took a mean time of 18±5 minutes and the average thermal ischemia duration was （3.0±1.5）minutes.The average time of surgery was （18±5.0）min. The pancreas combined kidney harvesting was performed in 2 cases, heart harvesting 5 cases and heart lung harvesting once. No primary dysfunction was found in all the graft. No injuries of the hepatic and renal arteries occurred. ［Conclusion］ It is suggested that this technique can shorten the thermal ischemic time, pledge the quality of harvesting organ, avoid iatrogenic injure of hepatic artery and make full use of cadaveric organs. The technique can be wildly used in clinics.