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目的总结活体亲属肾移植的临床经验。方法对供、受者进行全面的免疫学检查,对供者行IVU检查了解分侧肾功能,行DSA或MRA、螺旋CT血管三维成像检查了解血管的变异情况之后,开放式手术摘取供肾13例,经后腹腔镜活体供肾摘取4例,按常规方法移植给受者。免疫抑制方案为环孢素A(或FK506)、霉酚酸酯(或硫唑嘌呤、雷帕鸣)、强的松三联免疫抑制剂。结果13例开放式手术时间1.5～3.0h,平均2.0h;热缺血时间1.0～1.5min,平均1.2min;术中出血量60～200ml,平均140ml,术中及术后均未输血;术后住院7～10d,平均8d。4例后腹腔镜手术时间3.0～4.5h,平均3.5h;热缺血时间2.5～3.5min,平均2.8min;术中出血量60～100ml,平均75ml,术中及术后均未输血;术后3～5d出院。移植肾血液循环恢复后10～40s泌尿,平均20s。1例受者术后45d发生轻微的急性排斥反应,应用激素冲击3d后逆转,其余受者均无并发症。随访4～60个月,人/肾存活率为100%,移植肾功能良好。结论活体亲属肾移植安全可行,取左肾尽量靠近腹主动脉壁切断肾动脉,取右肾切取少许下腔静脉片。
Objective To summarize the clinical experience of living relatives kidney transplantation. Methods A comprehensive immunological examination of donors and recipients was carried out. The patients underwent IVU examination to understand the function of differentiated side of the kidney, DSA or MRA, three-dimensional spiral CT angiography examination to understand the variation of blood vessels. Thirteen patients were treated by retroperitoneal laparoscopic biopsy in 4 cases and were transplanted to recipients according to the conventional method. Immunosuppressive regimens were cyclosporin A (or FK506), mycophenolate mofetil (or azathioprine, lepamming), and prednisone triple immunosuppressants. Results Thirteen patients underwent open surgery for 1.5-3.0 hours with an average of 2.0 hours. The duration of warm ischemia was 1.0-1.5 minutes (average 1.2 minutes). The intraoperative blood loss was 60-200 ml (average 140 ml) After hospitalization 7 ~ 10d, an average of 8d. 4 cases of laparoscopic surgery time 3.0 ~ 4.5h, an average of 3.5h; warm ischemia time 2.5 ~ 3.5min, an average of 2.8min; intraoperative blood loss of 60 ~ 100ml, an average of 75ml, intraoperative and postoperative blood transfusion were not; surgery After 3 ~ 5d discharged. Transplanted kidney blood circulation recovery after 10 ~ 40s urinary tract, an average of 20s. One case received mild acute rejection at 45 days postoperatively. Hormone shock was used to reverse the symptoms after 3d and no complications were found in the remaining recipients. After 4 to 60 months of follow-up, the survival rate of human / kidney is 100%, and the function of renal graft is good. Conclusion Living relatives kidney transplantation is safe and feasible. Take the left kidney as close as possible to the abdominal aorta wall to cut off the renal artery, and take the right kidney and cut a little inferior vena cava.