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目的总结亲属活体肾脏移植供受者外科手术的经验。方法近2年施行的30例亲属活体移植,术前均行供体16层螺旋CT供肾血管造影及三维重建。第1例采用手助腹腔镜切取供肾,29例采取开放手术切取供肾。右肾供肾手术20例,左肾供肾10例,包括腹腔镜1例。经腹腔20例,经腰12肋切口腹膜后10例。28例右侧髂窝肾移植,2例左侧髂窝肾移植,移植肾动脉-受者髂内动脉间断端端缝合吻合28例,其中3例供肾双支动脉分别与髂内动脉2分支吻合,受者髂内静脉、髂外静脉盆腔分支完全结扎松解髂外静脉后行移植肾静脉-髂外静脉端侧连续缝合吻合。26例输尿管-膀胱黏膜下隧道式吻合,2例输尿管端侧吻合,2例输尿管端端吻合,内置支架管2周或以上,无输尿管并发症。结果30例供者手术顺利,仅1例供者发生术侧气胸,闭式引流2 d恢复,术后1周痊愈出院。受者移植肾功能良好,2~3周痊愈出院,无移植肾外科手术并发症。结论术前16层螺旋CT血管造影及三维重建是准确了解供者供肾血管情况的有效方法,开放手术和腹腔镜取肾都是安全的取肾方式,腹腔镜手术费用过高开展受限,肾移植手术动脉吻合以受者髂内动脉-移植肾动脉吻合为首选,有利于弥补供肾动脉过短过细带来的吻合困难及多支动脉处理,结扎髂内静脉及髂外静脉盆腔分支有利于增加髂外静脉活动度,利于移植肾平顺安放在髂窝。各术式输尿管吻合在保留内支架管2周以上时是安全可靠的。
Objective To summarize the experience of donor living donor renal transplant surgery. Methods Thirty relatives living in the past two years were treated with donor 16-slice spiral CT for renal angiography and three-dimensional reconstruction. The first case of hand-assisted laparoscopic excision of the kidneys, 29 cases of open surgery for kidney. Right kidney renal surgery in 20 cases, left renal insufficiency in 10 cases, including laparoscopy in 1 case. Twenty cases were treated by peritoneal cavity and 10 cases were peritoneally incised by lumbar 12-slice incision. 28 cases of right iliac fossa kidney transplantation, 2 cases of left iliac fossa kidney transplantation, transplantation of renal artery - recipient internal iliac artery intermittent end suture anastomosis in 28 cases, of which 3 cases of renal artery branch and internal iliac artery 2 branch Anastomosis, the recipients of iliac vein, external iliac vein pelvic branches ligation completely loosen the iliac vein after transplantation renal vein - external iliac vein side of the continuous anastomosis. Twenty-six ureteral-bladder submucosal tunnel anastomoses, two ureteral end-to-side anastomoses, two ureteral end-to-end anastomoses, and stent-free tubes for two weeks or more without ureteral complications. Results Thirty donors were operated successfully. Only one patient had pneumothorax and closed drainage for 2 days. One week after the operation, the patients were discharged. Recipient kidney function is good, 2 to 3 weeks cured discharged, no complications of transplanted renal surgery. Conclusion 16-slice spiral CT angiography and three-dimensional reconstruction before surgery is an effective way to understand the situation of donor’s blood supply to the renal artery. Open surgery and laparoscopy are both safe renal access and laparoscopic surgery is limited. Renal transplantation anastomosis to the recipients of internal iliac artery - graft renal artery anastomosis as the first choice is conducive to make up for too short supply of renal artery anastomosis caused by difficulty and multi-branch arterial treatment, ligation of the iliac vein and external iliac vein pelvic branches Will help increase the activity of the external iliac vein, which will help the smooth grafting of the kidney graft in the iliac fossa. All kinds of ureteral anastomosis in the retention of the stent tube more than 2 weeks is safe and reliable.