切换至 "中华医学电子期刊资源库"

中华移植杂志(电子版) ›› 2023, Vol. 17 ›› Issue (03) : 146 -151. doi: 10.3877/cma.j.issn.1674-3903.2023.03.004

论著

不破坏膈肌式肝肾联合获取术总结分析
杨锦然, 李新长, 何小平, 傅俊, 龙成美(), 陈志铭   
  1. 330000 南昌,江西省人民医院(南昌医学院第一附属医院)器官移植科
    330000 南昌大学医学院
    330000 南昌大学建筑与设计学院
  • 收稿日期:2023-02-09 出版日期:2023-06-25
  • 通信作者: 龙成美

Summary and analysis of combined liver and kidney procurement technology without destruction of diaphragm

Jinran Yang, Xinchang Li, Xiaoping He, Jun Fu, Chengmei Long(), Zhiming Chen   

  1. Department of Organ Ttransplantation, Jiangxi Provincial People′s Hospital, Nanchang 330000, China
    Medical College of Nanchang University, Nanchang 330000, China
    School of Architecture and Design of Nanchang University, Nanchang 330000, China
  • Received:2023-02-09 Published:2023-06-25
  • Corresponding author: Chengmei Long
引用本文:

杨锦然, 李新长, 何小平, 傅俊, 龙成美, 陈志铭. 不破坏膈肌式肝肾联合获取术总结分析[J/OL]. 中华移植杂志(电子版), 2023, 17(03): 146-151.

Jinran Yang, Xinchang Li, Xiaoping He, Jun Fu, Chengmei Long, Zhiming Chen. Summary and analysis of combined liver and kidney procurement technology without destruction of diaphragm[J/OL]. Chinese Journal of Transplantation(Electronic Edition), 2023, 17(03): 146-151.

目的

探讨不破坏膈肌式肝肾联合获取术在肝肾联合获取中的有效性及安全性。

方法

回顾性分析2015年1月1日至2021年9月1日江西省人民医院器官获取组织实施的330例公民逝世后器官捐献供者临床资料,其中111例采取传统破坏膈肌式肝肾联合获取术,纳入破坏膈肌组;219例采取不破坏膈肌式肝肾联合获取术,纳入不破坏膈肌组。比较两组供者体质指数、供器官获取手术时间、供器官热缺血时间、供器官血管损伤和供者胃肠道损伤率以及器官灌注液培养阳性率。正态分布计量资料采用独立样本t检验进行比较,计数资料采用χ2检验进行比较。P<0.05为差异有统计学意义。

结果

破坏膈肌组和不破坏膈肌组供器官灌注液培养阳性率分别为18.0%(20/111)和8.7%(19/219),差异有统计学意义(χ2=6.169,P<0.05),两组其余一般资料差异均无统计学意义(P均>0.05)。破坏膈肌组和不破坏膈肌组受者围手术期抗菌药物使用时间分别(8.0±0.4)和(6.6±0.1)d,差异有统计学意义(t=3.82,P<0.05)。两组供器官灌注液培养阳性菌均以鲍曼不动杆菌和大肠埃希菌等为主。

结论

较传统破坏膈肌式肝肾联合获取术,不破坏膈肌式肝肾联合获取术在不破坏膈肌的前提下器官灌注液培养阳性率更低,该术式安全、有效。

Objective

To explore the effectiveness and safety of non-destructive diaphragm combined liver and kidney procurement.

Methods

A retrospective analysis was conducted on the clinical data of 330 donors from organ donation after citizen′s death of organ procurement organization of Jiangxi Provincial People′s Hospital from January 1, 2015 to September 1, 2021. 111 cases underwent traditional destructive diaphragm combined liver and kidney procurement surgery were enrolled in the destructive diaphragm group; 219 cases underwent non-destructive diaphragm combined liver and kidney procurement surgery were enrolled in the non-destructive diaphragm group. The donor body mass index, donor organ acquisition surgery time, donor organ warm ischemia time, donor organ vascular injury and donor gastrointestinal injury rates, positive rate of organ perfusion fluid culture between the two groups were compared. The measurement data of normal distribution were compared by two independent samples t-test, and the enumeration data were compared by chi-square test. P<0.05 indicates a statistically significant difference.

Results

The positive rates of donor organ perfusion fluid culture in the destructive diaphragm group and non-destructive diaphragm group were 18.0% (20/111) and 8.7% (19/219), respectively, with a statistically significant difference (χ2=6.169, P<0.05). There was no statistically significant difference in other general data between the two groups (all P>0.05). The perioperative use time of antibacterial drugs in the destructive diaphragm group and non-destructive diaphragm group were (8.0±0.4) d and (6.6±0.1) d, respectively, with a statistically significant difference (t=3.82, P<0.05). The positive bacteria of organ perfusion fluid culture of the two groups were dominated by Acinetobacter baumannii and Escherichia coli.

Conclusions

Compared with traditional destructive diaphragm combined liver and kidney procurement surgery, non-destructive diaphragm combined liver and kidney procurement surgery has a lower incidence of organ perfusion fluid culture without diaphragm destruction. This surgery is safe and effective.

图1 不破坏膈肌式肝肾联合获取术游离及切取肝脏和肾脏示意图注:a.于膈肌腔静脉裂孔层面离断肝上、下腔静脉;b.游离腹主动脉后侧壁与左、右膈肌脚;c.在保护两侧膈肌脚情况下于腹腔干以上位置离断腹主动脉;d.肝肾整体取出后膈肌保留完整
表1 破膈肌组与不破坏膈肌组肝肾联合获取供者及其供器官相关临床资料比较
表2 破坏膈肌组与不破坏膈肌组肝肾联合获取供者供器官灌注液培养病原菌情况(例)
1
Lewis A, Koukoura A, Tsianos GI, et al. Organ donation in the US and Europe: the supply vs demand imbalance[J]. Transplant Rev (Orlando), 2021, 35(2):100585.
2
Wolfe CR, Ison MG; AST Infectious Diseases Community of Practice. Donor-derived infections: guidelines from the American Society of Transplantation Infectious Diseases Community of Practice[J]. Clin Transplant, 2019, 33(9): e13547.
3
Schnitzbauer AA, Bechstein WO. Technik der Leberentnahme bei postmortaler Spende [Technique of liver procurement in postmortem donation] [J]. Chirurg, 2013, 84(5):380-384.
4
Kootstra G, Daemen JH, Oomen AP. Categories of non-heart-beating donors[J]. Transplant Proc, 1995, 27(5): 2893-2894.
5
Sui M, Zhang L, Yang J, et al. A new HC-A Ⅱ solution for kidney preservation: a multi-center randomized controlled trial in China[J]. Ann Transplant, 2014, 19: 614-620.
6
Keutgen XM, Petrowsky H. Procurement for visceral organ transplantation: where to cannulate and how to perfuse?[J]. Curr Opin Organ Transplant, 2014, 19(2): 92-99.
7
郑树森. 中国肝移植的发展之路[J/CD]. 中华移植杂志:电子版2019, 13(4): 259-261.
8
Roberts KL, Micek ST, Juang P, et al. Controversies and advances in the management of ventilator associated pneumonia[J]. Expert Rev Respir Med, 2017, 11(11): 875-884.
9
Zhao J, Li LQ, Chen CY, et al. Do probiotics help prevent ventilator-associated pneumonia in critically ill patients? A systematic review with meta-analysis[J]. ERJ Open Res, 2021, 7(1): 00302-2020.
10
Martin-Loeches I, Rodriguez AH, Torres A. New guidelines for hospital-acquired pneumonia/ventilator-associated pneumonia: USA vs. Europe[J]. Curr Opin Crit Care, 2018, 24(5): 347-352.
11
Jean SS, Chang YC, Lin WC, et al. Epidemiology, treatment, and prevention of nosocomial bacterial pneumonia[J]. J Clin Med, 2020, 9(1): 275.
12
Rahman NM, Kahan BC, Miller RF, et al. A clinical score (RAPID) to identify those at risk for poor outcome at presentation in patients with pleural infection[J]. Chest, 2014, 145(4): 848-855.
13
Santoshi RK, Chandar P, Gupta SS, et al. From chest wall resection to medical management: the continued saga of parapneumonic effusion management and future directions[J]. Cureus, 2022, 14(1): e21017.
14
Dean NC, Griffith PP, Sorensen JS, et al. Pleural effusions at first ED encounter predict worse clinical outcomes in patients with pneumonia[J]. Chest, 2016, 149(6): 1509-1515.
15
Sotiropoulos GC, Kostakis ID, Prodromidou A, et al. Contamination of the preservation solution in solid organ transplantation[J]. Transplant Proc, 2019, 51(2):392-395.
16
Herati RS, Blumberg EA. Losing ground: multidrug-resistant bacteria in solid-organ transplantation[J]. Curr Opin Infect Dis, 2012, 25(4):445-449.
17
Grossi PA. Donor-derived infections, lessons learnt from the past, and what is the future going to bring us[J]. Curr Opin Organ Transplant, 2018, 23(4): 417-422.
18
Kahle W, Leonhardt H, Platzer W. 人体解剖学及彩色图谱[M]. 毕玉顺,李振华译.山东:山东科学技术出版社,2001.
19
Reich DJ, Mulligan DC, Abt PL, et al. ASTS recommended practice guidelines for controlled donation after cardiac death organ procurement and transplantation[J]. Am J Transplant, 2009, 9(9):2004-2011.
20
Reich DJ, Mulligan DC, Abt PL, et al. ASTS recommended practice guidelines for controlled donation after cardiac death organ procurement and transplantation[J]. Am J Transplant, 2010, 9(9):2004-2011.
21
Gao V. Perioperative nurses′ attitudes towards organ procurement: a systematic review[J]. J Clin Nurs, 2017, 26(3-4):302-319.
[1] 张璇, 马宇童, 苗玉倩, 张云, 吴士文, 党晓楚, 陈颖颖, 钟兆明, 王雪娟, 胡淼, 孙岩峰, 马秀珠, 吕发勤, 寇海燕. 超声对Duchenne肌营养不良儿童膈肌功能的评价[J/OL]. 中华医学超声杂志(电子版), 2023, 20(10): 1068-1073.
[2] 杨茂宪, 沈鹏, 王倩倩, 吴旺, 沈永帅, 蒋禛, 徐龙生, 朱建刚, 刘倍倍. 吡啶甲酸镁联合地塞米松对急性呼吸窘迫综合征大鼠的治疗作用研究[J/OL]. 中华危重症医学杂志(电子版), 2024, 17(03): 196-203.
[3] 江文诗, 侯峰忠. 全球视野下中国人体器官捐献事业的高质量发展:2010~2024[J/OL]. 中华移植杂志(电子版), 2024, 18(04): 204-212.
[4] 裘妃, 高志刚, 汪伟, 王晓豪, 杨子浩, 陈青江, 盛美君, 赵杭燕. 儿童器官获取组织和器官移植管理体系的探索与实践[J/OL]. 中华移植杂志(电子版), 2024, 18(02): 93-97.
[5] 巨春蓉, 门同义, 薛武军. 实体器官移植后难治性/耐药性巨细胞病毒感染诊疗进展[J/OL]. 中华移植杂志(电子版), 2024, 18(02): 86-92.
[6] 王惠英, 孙永康, 武小桐. 省级器官获取组织与医疗机构间协同联动提高器官捐献率的方法探讨[J/OL]. 中华移植杂志(电子版), 2024, 18(01): 12-16.
[7] 巨春蓉, 孙启全, 薛武军. 器官移植受者非结核分枝杆菌病诊疗进展[J/OL]. 中华移植杂志(电子版), 2024, 18(01): 1-6.
[8] 尚丽红, 武小桐, 李宁, 石韶华, 王志华, 朱琳茹, 周华. 非HLA抗体检测方法研究进展[J/OL]. 中华移植杂志(电子版), 2024, 18(01): 60-64.
[9] 贾俊君, 殳儆, 唐秋梅, 丁维燕, 郑树森. 叙事医学在器官移植中的应用及价值[J/OL]. 中华移植杂志(电子版), 2023, 17(06): 381-384.
[10] 季茹, 赵婕, 程子韵, 蒲苗, 赵洪涛, 霍枫. 美国器官移植体系未来发展指导意见及对我国的启示[J/OL]. 中华移植杂志(电子版), 2023, 17(06): 332-337.
[11] 江文诗, 何湘湘. 全球及我国器官捐献发展特征分析与学科建设[J/OL]. 中华移植杂志(电子版), 2023, 17(05): 280-286.
[12] 中华医学会器官移植学分会, 中国医师协会器官移植医师分会, 上海医药行业协会. 中国肝、肾移植受者霉酚酸类药物应用专家共识(2023版)[J/OL]. 中华移植杂志(电子版), 2023, 17(05): 257-272.
[13] 周丽, 刘晅, 荆璐, 李娜, 王齐国. 基于膈肌超声的RSBI对无创通气撤机成功的预测意义[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(03): 450-453.
[14] 梁明, 魏珍, 祖合热·肉孜, 李金贤. 超声评估脑卒中气管切开患者膈肌功能与肺功能的相关性研究[J/OL]. 中华脑科疾病与康复杂志(电子版), 2024, 14(03): 133-139.
[15] 詹崇文, 汪洁, 沈奇伟, 花荣, 姚琪远. 胃袖状切除术联合膈肌脚塑形术对术后胃食管反流的影响[J/OL]. 中华胃食管反流病电子杂志, 2024, 11(01): 1-5.
阅读次数
全文


摘要