腹主动脉联合门静脉快速灌注法在器官捐献供体肝肾联合获取中的应用

Application of fast perfusion through abdominal aorta and portal vein in combined liver and kidney procurement from organ donation

    摘要
  • 摘要:
      目的  总结腹主动脉联合门静脉快速灌注法在器官捐献供体肝肾联合获取中的可行性和安全性。
      方法  回顾性分析2011年9月至2014年6月在佛山市第一人民医院完成的43例中国心脏死亡供体器官捐献肝肾联合获取的临床资料。43例供体中, 中国心脏死亡供体分类一类(脑死亡供体)(C-Ⅰ类)15例, 中国二类(心脏死亡供体)(C-Ⅱ类)1例, 中国三类(脑-心双死亡捐献供体)(C-Ⅲ类)27例。器官灌注采用腹主动脉、门静脉快速插管联合灌注法。
      结果  开腹至腹主动脉插管时间约1.5~2.0 min, 43例供体共获得肝脏43个, 肾脏86个。C-Ⅰ类供体热缺血时间全部为0, 其余供体热缺血时间范围为3~21 min, 平均10 min。2例供肝分别因肝门部严重损伤和重度脂肪肝弃用, 18例供肾分别因肾结石、肾萎缩、术前血清肌酐水平较高、肾动脉粥样硬化严重、肾微小血管血栓、多发肾囊肿、外伤性肾破裂等原因弃用, 供体器官总弃用率为16%。
      结论  腹主动脉联合门静脉快速灌注法是器官捐献供体肝肾联合获取的简单、安全的方法。

     

    Abstract:
      Objective  To summarize the feasibility and safety of fast perfusion through abdominal aorta and portal vein in combined liver and kidney procurement from organ donation.
      Methods  Clinical data of 43 donors of donation after cardiac death (DCD) undergoing combined liver and kidney procurement in the First People's Hospital of Foshan from September 2011 to June 2014 were analyzed retrospectively. Among the 43 donors, 15 cases were China DCD donor category Ⅰ(donor after brain death)(C-Ⅰ), 1 case was category Ⅱ (donor after cardiac death)(C-Ⅱ) and 27 cases were category Ⅲ (C-Ⅲ). Combined abdominal aorta and portal vein perfusion with fast cannulation were performed.
      Results  The time from abdomen incision to abdominal aorta cannulation was 1.5-2.0 min. Forty-three livers and eighty-six kidneys were procured from 43 donors. The warm ischemia time (WIT) was 0 for C-Ⅰ donors, and was 3-21 min for the other donors (mean:10 min). Two liver grafts were discarded for major injury of the porta hepatis and severe fatty liver respectively. Eighteen kidney grafts were discarded for kidney stones, kidney atrophy, high level of preoperative serum creatinine, severe renal atherosclerosis, renal microvessel thrombosis, multiple renal cyst, kidney traumatic rupture, etc. The total discard rate of donor organs was 16%.
      Conclusions  Fast perfusion through abdominal aorta and portal vein is a simple and safe method in combined procurement liver and kidney from organ donation.

     

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