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Objective:To explore the factors related to the difficulty of adult allogeneic renal transplantation.Methods:Used retrospective study method, a total of 183 patients who were diagnosed with end-stage renal disease and underwent allogeneic kidney transplantation in Beijing Friendship Hospital, Capital Medical University from January 2020 to December 2021 were included in this study. With kidney transplant operation time as the evaluation criteria of operation difficulty, relevant clinical indicators that may affect the difficulty of surgery were collected, including recipient age, body mass index, pretransplant dialysis mode, blood lipid level, subcutaneous fat thickness, vascular anastomosis mode, donor kidney length, donor kidney volume, etc. Pearson, Spearman correlation test were used to analyze the correlation between the above indexes and surgical difficulty.Results:In terms of recipients, higher body mass index ( P=0.006), peritoneal dialysis before transplantation ( P=0.035), higher serum cholesterol ( P=0.016) and triglyceride ( P<0.001), thicker subcutaneous fat ( P=0.032) and calcification of the vessels ( P<0.001) all lead to increase the difficulty of kidney transplantation, and also prolong the operation time; in terms of kidney donors, the longer and larger of transplanted kidney length ( P<0.001) and volume ( P<0.001), the longer operation time will be cost. Meanwhile, the anastomosis of complex multi-vessel between kidney transplantation and recipient was more difficult than single internal iliac artery and single external iliac artery anastomosis ( P=0.005), and the operation time was also longer. Conclusions:The degree of obesity before transplantation, dialysis mode, blood lipid level, donor kidney size and vascular anastomosis mode were all factors affecting the difficulty of kidney transplantation. For patients with those above risk factors, the operation may be difficult and the surgical time can be much longer. Physicians with more experience in kidney transplantation can be selected to shorten the operation time, even reduce complications after operation.
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To investigate the possibility of microsurgical anastomosis of artery, vein and lymphat-ic vessel under 3-dimension screen without eyepiece. Methods During March, 2019, 2 cases (48 and 62 years old) were operated for breast reconstruction, chest wall deformity modified, and axillary scar contracture release, under 3-dimension screen without eyepiece.Deep epigastric artery perforators (artery and vein) dissections were carried on, and microsurgical anastomosis of artery, vein and lymphatic vessel were finished. Coupler was used to do the end-to-end anastomosis of veins (2.5 mm), interrupted suture end-to-end anastomosis with 9-0 nylon for artery (2.0 mm). Reverse arm lymphatic dynamic fluorescence methylene blue tracer under Near Infrared Imaging was used to test the func-tion of lymphatic system. The ends of 2 dominant drainage lymphatic vessels was found in the released axillary area (0.2 mm and 0.3 mm, respectively), and were anastomosis to the vein (0.5 mm) of lateral chest lymphatic tissue.Im-mediate methylene blue tracer under near infrared imaging was used to confirm the patency of lymphatic vessels-veins anastomosis and follow-up post operation. Flap were monitored use HHD. Results Two patients recovered well, and the flaps survived completely with appreciated appearances. The lymphedema of the arms were getting better, the peripheral diameter was reduced by about 2.0 cm compared with that before operation. Conclusion The technique of microsurgical anastomosis of artery, vein and lymphatic vessel without eyepiece under 3-dimension screen is possi-ble and safe.
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Objective To compare the reliability and effectiveness of anterolateral thigh flap with double vein anastomosis or one vein anastomosis for reconstruction of head and neck defects.Methods Two hundred and sixty four cases of anterolateral thigh flap transfers for head and neck reconstruction from January,2013 to September,2013 in the Second Xiangya Hospital of Central South University were reviewed.260 patients were randomly divided into 2 groups.In the experimental group,there were 138 patients 140 cases of anterolateral thigh flap with one vein one artery anastomosis.In the control group,there were 122 patients 124 cases of anterolateral thigh flap with double vein one artery anastomosis.Results Among 264 anterolateral thigh flaps,the overall success rate of free flap was 98.1％ (259/264),5 free flaps were lost.In the experimental group,there were 6 free flaps occurred venous thrombosis,two of them were lost.In the control group,there were 5 cases occurred venous thrombosis,three of them were lost.No arterial thrombosis occurred in both groups.The time of micromanipulation was 18 to 101 min,with the average of 47 min in the experimental group.In the control group,the time was 45 to 133 min,with the average of 71 min.(P =0.0003).Conclusion Anterolateral thigh flap with one vein one artery anastomosis for head and neck reconstruction did not affect the survival rate but it can absolutely reduce the operation time.
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Objective To verify the ability of distal ends of internal mammary artery and vein used as recipient vessels on breast and chest wall reconstruction. Methods Four bilateral (left 2 and right 2) scent pig buttock island flaps pedicled circle deep iliac artery and vein were used by comparing the different hemodynamic parameters (pressure; flux volume; perfusion unions) between the original pedicl artery (deep iliac artery), proximal and distal ends of internal mammary artery. The free flaps were transplantated by anastomosed end-end to the distal-ends of internal mammary artery and vein after the proximal ends were ligated. Results The pressure of distal end of internal mammary artery was 61%-65% of the pressure with original pedicl artery (deep iliac artery), the immediate volume of anastomasis stoma was a little lower than that of original pedicl artery. The flap, 15 cm?30 cm?2 cm in size, completely survived more than 14 days after operation. Conclusion The slightly decreased distal arterial pressure does not compromise flap survival. Bilateral scent pig buttock island flap pedicled circle deep iliac artery and vein is an ideal animal flap model. This hymodynamic model can be widely used .
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Objective To investigate the effect of pancreatic transplantion(PTA) using diverse operative (methods) in rats. Method Inbred SD rats were used as donor and recipient, and were randomly assigned (into) 4 groups:Normal control group( Group NC), consisted of 10 rats;diabetes group(Group DC) consisted of 10 rats;PTA with enteric drainage group(Group E-D), consisted of 22 diabetic rats;PTA using bladder reconstruction group(group B-D), consisted of 22 rats.Arterial supply of transplanted pancreas was (performed) by using end-to-side anastomosis of the donors' abdominal aorta(with splenic artery) and (recipients)′ abdominal aorta; and venous drainage was performed by using end-to-end anastomosis of the (donors)' portal vein segment(with splenic vein) and (recipients)′ left renal vein(cuff method). The fasting blood glucose, body weight, food intake, water intake and urine volume of the recipient were monitored before transplantation and on the 1st, 3rd, 7th, 14th, 30th day after operation, and also the reasons of failures were analyzed. Results The operative time of recipient in E-D group was significantly longer than that in B-D group(P