Furness P D, Houston J B, Grampsas S A, Karrer F M, Firlit C F, Koyle M A
Division of Pediatric Urology, Children's Memorial Hospital, Chicago, IL, USA.
J Urol. 2001 Sep;166(3):1042-5.
Extraperitoneal renal transplantation is not routine in small recipients, in whom transperitoneal engraftment is the norm. The outcome of extraperitoneal placement of renal allografts in children weighing less than 15 kg. was evaluated at 2 institutions.
We retrospectively reviewed all pediatric renal transplantations at 2 institutions from 1988 to 2000 and identified 29 children 14 to 72 months old (mean age 29.2) weighing less than 15 kg. (range 8 to 14.8, mean 11.2). All children underwent allograft placement extraperitoneally via a modified Gibson and low midline retroperitoneal incision in 27 and 2, respectively. A concurrent procedure was done via the same incision during 2 ipsilateral and 2 bilateral nephrectomies.
Of the 29 patients 25 have a functioning renal allograft. In 2 cases the initial allograft was lost due to early postoperative thrombosis and acute rejection in 1 each. Two patients with a functioning allografts died of medical complications greater than 2 years after transplantation. One child required reexploration secondary to fascial dehiscence and an additional recipient required pyeloureterostomy due to ureteral necrosis after living related donor transplantation.
Extraperitoneal renal transplantation is technically feasible in children who weigh less than 15 kg. This approach preserves the peritoneal cavity, limits potential gastrointestinal complications and allows the confinement of potential surgical complications, such as bleeding and urinary leakage. In addition, this approach provides complete access to the retroperitoneum to enable concurrent retroperitoneal surgery, such as nephrectomy, to be performed safely. We recommend that extraperitoneal renal engraftment should become routine in children weighing less than 15 kg. rather than using the more common transperitoneal approach for allograft placement.
在小体重受者中，腹膜外肾移植并非常规操作，他们通常采用经腹腔植入。对两家机构中体重不足15千克儿童进行的肾移植采用腹膜外植入的结果进行了评估。
我们回顾性分析了1988年至2000年两家机构所有的小儿肾移植病例，确定了29名年龄在14至72个月（平均年龄29.2岁）、体重不足15千克（范围8至14.8千克，平均11.2千克）的儿童。所有儿童均通过改良吉布森切口和低位中线腹膜后切口进行腹膜外移植，分别为27例和2例。在2例同侧和2例双侧肾切除术中，通过相同切口同时进行了其他手术。
29例患者中有25例移植肾功能良好。2例患者中，1例因术后早期血栓形成导致初始移植肾丢失，另1例因急性排斥反应丢失。2例移植肾功能良好的患者在移植后2年以上死于内科并发症。1名儿童因筋膜裂开需要再次手术探查，另1名受者在亲属活体供肾移植后因输尿管坏死需要进行肾盂输尿管吻合术。
腹膜外肾移植在体重不足15千克的儿童中技术上是可行的。这种方法保留了腹腔，限制了潜在的胃肠道并发症，并能将潜在的手术并发症（如出血和尿漏）局限在一定范围内。此外，这种方法能完全暴露腹膜后间隙，使同时进行腹膜后手术（如肾切除术）能够安全进行。我们建议，对于体重不足15千克的儿童，腹膜外肾移植应成为常规操作，而不是对所有移植均采用更常用的经腹腔方法。
