不破坏膈肌式肝肾联合获取术总结分析

doi:10.3877/cma.j.issn.1674-3903.2023.03.004

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。

关键词: 肝肾联合获取, 器官移植, 膈肌

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.

Key words: Combined liver and kidney procurement, Organ transplantation, Diaphragm

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

组别	例数	供者体质指数(kg/m²，±s)	供器官获取手术时间(min，±s)	器官热缺血时间(min，±s)	供器官血管损伤[例(%)]	供者胃肠道损伤[例(%)]	供器官灌注液培养阳性[例(%)]
破坏膈肌组	111	21.98±0.16	31.9±1.43	7.0±0.8	2(1.8)	2(1.8)	20(18.0)
不破坏膈肌组	219	22.02±0.11	31.9±1.47	6.9±0.8	3(1.4)	3(1.4)	19( 8.7)
t/χ²值	－	0.23	0.05	1.15	0.09	0.09	6.17
P值	－	>0.05	>0.05	>0.05	>0.05	>0.05	<0.05

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

组别	例数	供者体质指数(kg/m²，±s)	供器官获取手术时间(min，±s)	器官热缺血时间(min，±s)	供器官血管损伤[例(%)]	供者胃肠道损伤[例(%)]	供器官灌注液培养阳性[例(%)]
破坏膈肌组	111	21.98±0.16	31.9±1.43	7.0±0.8	2(1.8)	2(1.8)	20(18.0)
不破坏膈肌组	219	22.02±0.11	31.9±1.47	6.9±0.8	3(1.4)	3(1.4)	19( 8.7)
t/χ²值	－	0.23	0.05	1.15	0.09	0.09	6.17
P值	－	>0.05	>0.05	>0.05	>0.05	>0.05	<0.05

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)

组别	鲍曼不动杆菌	洛菲不动杆菌	醋酸不动杆菌	大肠埃希菌	念珠菌	阴沟肠杆菌	肺炎克雷伯菌	铜绿假单胞菌	屎肠球菌	葡萄球菌	腐生葡萄球菌	合计
破坏膈肌组	4	2	2	5	1	1	1	3	1	0	0	20
不破坏膈肌组	1	0	1	7	2	1	1	1	3	1	1	19

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)

组别	鲍曼不动杆菌	洛菲不动杆菌	醋酸不动杆菌	大肠埃希菌	念珠菌	阴沟肠杆菌	肺炎克雷伯菌	铜绿假单胞菌	屎肠球菌	葡萄球菌	腐生葡萄球菌	合计
破坏膈肌组	4	2	2	5	1	1	1	3	1	0	0	20
不破坏膈肌组	1	0	1	7	2	1	1	1	3	1	1	19

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

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