探讨运用三维重建技术进一步优化开放式活体肾移植供肾切取术的临床效果。

选取2017年1月至2020年1月于西安交通大学第一附属医院完成的活体肾移植供受者，根据供者术前是否采取三维重建技术分为三维重建组(60例)和传统术式组(60例)。三维重建组术前通过获取供者双肾医学数字成像和通信数据进行三维重建，并根据重建模型制订手术方案或进行模拟手术。传统术式组通过常规动、静脉计算机体层血管成像(CTA)、输尿管CT造影及超声等了解手术部位解剖结构。观察供者年龄、性别、体质指数、手术时间、术中出血量、血管变异、供肾热缺血时间、并发症和血清肌酐水平，以及受者术后移植肾功恢复时间、移植物功能延迟恢复(DGF)发生率以及血清肌酐水平。正态分布计量资料采用配对t检验进行比较，计数资料采用卡方检验进行比较。P<0.05为差异有统计学意义。

三维重建组术前经三维重建发现22例(36.7%)存在血管变异，传统术式组术前经CTA等常规检查发现11例(18.3%)存在血管变异，两组血管变异诊断率差异有统计学意义(χ²＝5.06，P<0.05)。三维重建组术中发现24例需要处理的血管变异，与术前评估诊断一致率为91.7%(22/24)；传统术式组术中发现20例血管变异，诊断一致率为55.0%(11/20)，二者相比差异有统计学意义(χ²＝7.82，P<0.05)。三维重建组供肾切取手术时间短于传统术式组，分别为(88±7)、(101±11)min；术中出血量少于传统术式组，分别为(80±18)、(93±19)mL，差异均有统计学意义(t＝6.50、3.55，P均<0.05)。三维重建组和传统术式组供者术后第1天血清肌酐水平分别为(69±14)、(87±13)μmol/L，差异有统计学意义(t＝6.82，P<0.05)。三维重建组受者术后移植肾功恢复正常时间为(3.7±2.4)d，短于传统术式组[(5.1±1.7)d]，差异有统计学意义(t＝2.43，P<0.05)。三维重建组受者术后第1天血清肌酐水平比传统术式组下降更快，分别为(427±21)、(531±31)μmol/L，差异有统计学意义(t＝4.45，P<0.05)。

三维重建技术可进一步优化活体肾移植供肾切取术，在一定程度上更好地保护供肾，降低手术风险。

To explore the clinical effect of three-dimensional (3D) reconstruction technology for optimizing donor nephrectomy in open living donor kidney transplantation.

Living kidney transplantation recipients who completed in the First Affiliated Hospital of Xi′an Jiaotong University from January 2017 to January 2020 were selected and divided into 3D reconstruction group (60 cases) and traditional operation group (60 cases) according to whether 3D reconstruction technology was used preoperatively. The 3D reconstruction group obtained the medical digital imaging and communication data of the donor′s kidney for 3D reconstruction, and the operation plan or simulated operation were made according to the reconstruction model. In the traditional operation group, conventional arteriovenous CT angiography (CTA), ureteral CTA and ultrasound were used to detect the anatomical structure of the surgical site. The age, sex, body mass index, time of operation, intraoperative blood loss, vascular variation, warm ischemia time of donor kidney, complications, intraoperative serum creatinine level, postoperative recovery time of transplanted kidney, the incidence of delayed graft function (DGF) and postoperative serum creatinine level of donors in two groups were observed. The measurement data of normal distribution were compared by paired t test. Enumeration data were compared by Chi-square test. P<0.05 indicates that the difference is statistically significant.

Vascular variation was found in 22 cases (36.7%) in the 3D reconstruction group before surgery, 11 cases (18.3%) in the conventional operation group after CTA and other routine examinations before surgery. The difference in the diagnostic rate of vascular variation between the two groups was statistically significant (χ²=5.06, P<0.05). In the 3D reconstruction group, 24 cases with vascular variation who were needed to be treated were found intraoperatively, with a consistent rate of 91.7% (22/24). Twenty cases with vascular variation were found in the traditional operation group, and the diagnostic consistency rate was 55.0% (11/20), the difference between the two groups was statistically significant (χ²=7.82, P<0.05). The operation time of donor kidney resection in the 3D reconstruction group [(88±7)min] was shorter than that in the traditional operation group [ (101±11) min]; the amount of intraoperative blood loss was less than that of the traditional operation group [(80±18) mL vs (93±19) mL], and the differences were statistically significant (t=6.50, 3.55, all P<0.05). The serum creatinine level of donors in 3D reconstruction group and traditional operation group were (69±14) and (87±13) μmol/L, respectively (t=6.82, P<0.05). The recovery time of transplanted kidney function in the 3D reconstruction group was shorter than that in the traditional operation group [(3.7±2.4)d vs (5.1±1.7)d] (t=2.43, P<0.05). The serum creatinine level of the 3D reconstruction group decreased faster than that of the traditional operation group on the first day after operation, respectively [(427±21) vs (531±31) μmol/L] (t=4.45, P<0.05).

3D reconstruction technology can further optimize donor nephrectomy of living kidney transplantation, which can better protect the donor kidney and reduce the risk of surgery.