切换至 "中华医学电子期刊资源库"

中华肝脏外科手术学电子杂志 ›› 2016, Vol. 05 ›› Issue (01) : 11 -15. doi: 10.3877/cma.j.issn.2095-3232.2016.01.004

所属专题: 文献

临床研究

心脏死亡器官捐献中器官获取的手术技巧
傅斌生1, 唐晖1, 易述红1, 李华1, 杨扬1, 陈规划1,()   
  1. 1. 510630 广州,中山大学附属第三医院肝移植中心
  • 收稿日期:2015-12-20 出版日期:2016-02-10
  • 通信作者: 陈规划
  • 基金资助:
    国家自然科学基金(81370575,81372243,81172036); 十二五科技重大专项(2012ZX10002016-023,2012ZX10002017-005); 广州市科技计划项目(201400000001-3,2014J4100183)

Surgical techniques of organ procurement from donation after cardiac death

Binsheng Fu1, Hui Tang1, Shuhong Yi1, Hua Li1, Yang Yang1, Guihua Chen1,()   

  1. 1. Liver Transplantation Center, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
  • Received:2015-12-20 Published:2016-02-10
  • Corresponding author: Guihua Chen
  • About author:
    Corresponding author: Chen Guihua, Email:
引用本文:

傅斌生, 唐晖, 易述红, 李华, 杨扬, 陈规划. 心脏死亡器官捐献中器官获取的手术技巧[J]. 中华肝脏外科手术学电子杂志, 2016, 05(01): 11-15.

Binsheng Fu, Hui Tang, Shuhong Yi, Hua Li, Yang Yang, Guihua Chen. Surgical techniques of organ procurement from donation after cardiac death[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2016, 05(01): 11-15.

目的

探讨心脏死亡器官捐献(DCD)中供体器官切取手术技巧及效果。

方法

回顾性分析2012年7月至2014年12月在中山大学附属第三医院行器官捐献的64例DCD供者临床资料。其中男52例,女12例;年龄25 d~57岁,中位年龄31岁。脑部损伤供者42例,脑血管意外18例,脑部神经系统疾病4例。供者家属均签署器官捐献同意书,符合医学伦理学规定。所有供者均采用原位腹主动脉-肠系膜上静脉快速灌注及肝肾联合快速切取分离的方法获取器官。

结果

所有器官切取手术均顺利完成,器官切取手术时间中位数为30(22~48)min。本组共获取64个肝脏、128个肾脏,分别成功用于肝移植58例、肾移植118例,肝肾联合移植2例;弃用器官12个,包括肝脏4个、肾脏8个。移植术后移植器官功能恢复良好,仅1例出现原发性移植肝无功能。

结论

在DCD器官切取手术中,快速灌注及肝肾联合快速切取法是保证高质量供体器官和提高手术疗效的关键。

Objective

To investigate the surgical techniques and effect of organ procurement from donation after cardiac death (DCD).

Methods

Clinical data of 64 DCD donors implementing organ donation in the Third Affiliated Hospital of Sun Yat-sen University from July 2012 to December 2014 were retrospectively analyzed. There were 52 males and 12 females, aged 25 d to 57 years with a median age of 31 years. Forty-two donors were with cerebral damage, 18 with cerebral vascular accidents and 4 with brain nervous system diseases. The agreement statement of organ donation signed by the family relatives of all donators were obtained and the local ethical committee approval had been received. Organ procurement was performed by in situ rapid perfusion of abdominal aorta-superior mesenteric vein and rapid retrieval and separation of liver-kidney.

Results

All the organ procurement operations were performed successfully. The median operative time was 30(22-48) min. Sixty-four livers and 128 kidneys were procured and successfully applied to 58 hepatic, 118 renal and 2 liver-kidney transplantations. Twelve organs including 4 livers and 8 kidneys were discarded. The graft function recovered well after operation except one developed primary graft failure.

Conclusion

In DCD organ procurement, rapid perfusion and retrieval of liver-kidney play a pivotal role in ensuring high-quality donated organs and enhancing surgical therapeutic effect.

[1]
Elgharably H, Shafii AE, Mason DP. Expanding the donor pool: donation after cardiac death[J]. Thorac Surg Clin, 2015, 25(1): 35-46.
[2]
Zhang L, Zeng L, Gao X, et al. Transformation of organ donation in China[J]. Transpl Int, 2015, 28(4): 410-415.
[3]
Chang HL, Qu K, Liu C, et al. Liver transplantation using DCD donors: the current strategy to expand the organ donor pool in China[J]. Am J Transplant, 2013, 13(7):1939-1940.
[4]
Doyle MB, Collins K, Vachharajani N, et al. Outcomes using grafts from donors after cardiac death[J]. J Am Coll Surg, 2015, 221(1): 142-152.
[5]
van der Hilst CS, Ijtsma AJ, Bottema JT, et al. The price of donation after cardiac death in liver transplantation: a prospective cost-effectiveness study[J]. Transpl Int, 2013, 26(4):411-418.
[6]
Firl DJ, Hashimoto K, O'Rourke C, et al. Impact of donor age in liver transplantation from donation after circulatory death donors: a decade of experience at Cleveland Clinic[J]. Liver Transpl, 2015, DOI: 10.1002/lt.24316[Epub ahead of print].
[7]
Xia W, Ke Q, Wang Y, et al. Donation after cardiac death liver transplantation: graft quality evaluation based on pretransplant liver biopsy[J]. Liver Transpl, 2015, 21(6): 838-846.
[8]
Ye H, Wang DP, Zhang CZ, et al. Pathological characteristics of liver allografts from donation after brain death followed by cardiac death in pigs[J]. J Huazhong Univ Sci Technolog Med Sci, 2014, 34(5):687-691.
[9]
Bae C, Pichardo EM, Huang H, et al. The benefits of hypothermic machine perfusion are enhanced with Vasosol and α-tocopherol in rodent donation after cardiac death livers[J]. Transplant Proc, 2014, 46(5):1560-1566.
[10]
Hessheimer AJ, Billault C, Barrou B, et al. Hypothermic or normothermic abdominal regional perfusion in high-risk donors with extended warm ischemia times: impact on outcomes?[J]. Transpl Int, 2015, 28(6):700-707.
[11]
Neyrinck A, Van Raemdonck D, Monbaliu D. Donation after circulatory death: current status[J]. Curr Opin Anaesthesiol, 2013, 26(3):382-390.
[12]
Schlegel A, Rougemont Od, Graf R, et al. Protective mechanisms of end-ischemic cold machine perfusion in DCD liver grafts[J]. J Hepatol, 2013, 58(2):278-286.
[13]
Brockmann JG. Liver damage during organ donor procurement in donation after circulatory death compared with donation after brain death[J]. Br J Surg, 2013, 100(3):381-386.
[14]
Gruttadauria S, Foglieni CS, Doria C, et al. The hepatic artery in liver transplantation and surgery: vascular anomalies in 701 cases[J]. Clin Transplant, 2001, 15(5):359-363.
[15]
Frongillo F, Lirosi MC, Nure E, et al. Diagnosis and management of hepatic artery complications after liver transplantation[J]. Transplant Proc, 2015,47(7):2150-2155.
[16]
Morrissey PE, Monaco AP. Donation after circulatory death: current practices, ongoing challenges, and potential improvements[J]. Transplantation, 2014, 97(3): 258-264.
[17]
Chan SC, Fan ST, Lo CM, et al. Toward current standards of donor right hepatectomy for adult-to-adult live donor liver transplantation through the experience of 200 cases[J]. Ann Surg, 2007, 245(1):110-117.
[1] 中国肝移植注册中心, 国家肝脏移植质控中心, 国家人体捐献器官获取质控中心, 国家骨科与运动康复临床医学研究中心, 中国医师协会器官移植医师分会移植器官质量控制专业委员会中国医院协会器官获取与分配工作委员会, 国家创伤医学中心器官保护专业委员会. 中国移植器官保护专家共识(2022版)[J]. 中华普通外科学文献(电子版), 2022, 16(04): 241-254.
[2] 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]. 中华移植杂志(电子版), 2023, 17(05): 280-286.
[3] 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]. 中华移植杂志(电子版), 2023, 17(05): 257-272.
[4] 中国康复医学会器官移植康复专业委员会. 成人实体器官移植后糖尿病管理专家共识[J]. 中华移植杂志(电子版), 2023, 17(04): 205-220.
[5] 巨春蓉, 何建行, 钟南山. 咪唑立宾在器官移植领域的应用及展望[J]. 中华移植杂志(电子版), 2023, 17(04): 227-231.
[6] 艾紫叶, 李玲, 何重香, 黄伟, 叶啟发. 猪器官异种移植研究进展[J]. 中华移植杂志(电子版), 2023, 17(03): 186-191.
[7] 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]. 中华移植杂志(电子版), 2023, 17(03): 146-151.
[8] 刘剑戎, 范明明, 郭煜. 器官捐献者转介时的临床特征分析[J]. 中华移植杂志(电子版), 2023, 17(03): 129-133.
[9] 国家传染病医学中心, 中华医学会器官移植学分会, 中国康复医学会器官移植康复专业委员会, 中国器官移植发展基金会器官移植受者健康管理专项基金. 实体器官移植受者新型冠状病毒感染诊疗专家共识(2023年版)[J]. 中华移植杂志(电子版), 2023, 17(02): 65-81.
[10] 陈琦, 郭嘉瑜, 陈忠宝, 马枭雄, 王天宇, 邹寄林, 张龙, 蔡治涛, 邱涛, 周江桥. 心肾联合移植三例[J]. 中华移植杂志(电子版), 2023, 17(02): 124-127.
[11] 陈琦, 郭嘉瑜, 陈忠宝, 马枭雄, 王天宇, 邹寄林, 张龙, 蔡治涛, 邱涛, 周江桥. 新型冠状病毒感染流行下我国器官捐献者筛选规则是否应时而变?[J]. 中华移植杂志(电子版), 2023, 17(02): 82-88.
[12] 中国器官移植发展基金会器官移植受者健康管理专家委员会. 器官移植受者新型冠状病毒感染防治策略与健康管理中国专家指导意见(第一版)[J]. 中华移植杂志(电子版), 2023, 17(01): 1-12.
[13] 任明仕, 王嵘, 王明岩, 张丽月, 成楠, 吴远斌. 异种心脏移植基因修饰策略及围手术期管理研究进展[J]. 中华移植杂志(电子版), 2022, 16(03): 183-189.
[14] 祝锦江, 白玲, 王华, 陈国振, 刘海平, 丁晨光. 区块链技术在公民逝世后器官捐献及移植工作中的应用探索[J]. 中华移植杂志(电子版), 2022, 16(03): 165-167.
[15] 贺海燕, 谢文照. 公民自愿捐献器官的家庭文化模式初步探讨[J]. 中华临床医师杂志(电子版), 2022, 16(12): 1269-1275.
阅读次数
全文


摘要