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[尸体供肾切除术。多器官捐献背景下的手术技术]

[Cadaver donor nephrectomy. Surgical technique in the context of multi-organ donation].

作者信息

Benoit G, Eschwege P, Decaux A, Alexandre L

机构信息

Service d'Urologie, CHU de Bicêtre, Le Kremlin Bicêtre.

出版信息

Prog Urol. 1996 Feb;6(1):114-22.

PMID:8624522
Abstract

95% of renal transplantations performed in France use cadaver donor kidneys. Two donor nephrectomy techniques are proposed: a beating heart technique and an arrested heart technique. In the very great majority of cases (80%), donor nephrectomy can be performed during multi-organ removal, performed according to bioethical regulations: unrelated, anonymity between donor and recipient, security, traceability and evaluation. The urologist has a role to play at each step of organ donation, in which he is the main protagonist. The first steps are performed in close collaboration with the intensive care unit which established the diagnosis of brain death of the potential donor. The following steps, guided by the French transplant establishment, are the urologist's responsibility: He is responsible for abdominal exploration looking for a tumour or any other abnormality. A strictly aseptic technique is essential to prevent contamination of the organ. He is responsible for removing kidneys in such a way as to ensure the shortest possible warm ischaemia time, the best storage solution, and the best preservation of their anatomical structure. He must be familiar with the outcome of transplants in order to adapt his technique to the results of transplants.

摘要

在法国进行的肾移植手术中,95% 使用的是尸体供肾。目前有两种供肾切除技术:心脏跳动技术和心脏停搏技术。在绝大多数情况下(80%),可在按照生物伦理规范进行的多器官切除过程中进行供肾切除,这些规范包括:非亲属关系、供受者之间匿名、安全性、可追溯性及评估。泌尿科医生在器官捐献的每一个环节都发挥着作用,是其中的主要角色。最初的步骤是与重症监护病房密切合作开展的,重症监护病房负责确定潜在供者的脑死亡诊断。接下来在法国移植机构的指导下,由泌尿科医生负责以下步骤:他负责进行腹部探查以寻找肿瘤或其他任何异常情况。严格的无菌技术对于防止器官污染至关重要。他负责以确保最短热缺血时间、最佳保存液以及最佳解剖结构保存的方式切除肾脏。他必须熟悉移植结果,以便根据移植结果调整自己的技术。

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