目的探讨婴幼儿供者肝肾联合切取时供肾切取和修整方法。方法 2012年8月至2013年5月,济南军区总医院成功完成5例婴幼儿心脏死亡器官捐献(DCD)供肾肾移植。5例婴幼儿供者中,男性4例,女性1例,中位年龄9个月(0.5~27个月),中位体质量为10 kg(4~14 kg),死亡原因为颅脑外伤4例、溺水1例;采用腹部器官联合切取法,取腹部“十字”切口,原位经单侧髂总动脉和门静脉插管,分别以0~4℃UW液2 000 m L灌洗,灌注压力约为80 cm H2O(1 cm H2O=0.098 k Pa);联合切取肝、肾,在工作台分离肝脏和肾脏,修整供肾。5例成人受者中,男性4例,女性1例,中位年龄37岁(28~38岁),中位体质量64kg(44~68 kg),原发病均为慢性肾小球肾炎;术前接受血液透析4例,接受腹膜透析1例,中位透析时间为17个月(6~30个月)。结果 5例成人受者均为首次肾移植,采用双肾整体移植术式,腹主动脉和下腔静脉远端与髂血管吻合,膀胱瓣与膀胱吻合或输尿管分别与膀胱吻合。供肾热缺血时间中位数为5 min(4~10 min),器官灌注良好,无血管损伤;冷缺血时间中位数为6 h(5~10 h)。1例受者术后1个月发生移植肾功能延迟恢复,血清肌酐维持在200μmol/L;其余4例受者术后6~9 d血清肌酐恢复正常,其中1例术后32 d发生移植肾动脉破裂导致受者死亡。1例受者术后14 d发生尿漏,再次手术后恢复。术后随访12~21个月,4例受者存活。结论婴幼儿DCD供器官切取较成人供者难度大,正确的供肾切取、保存及修整方法是保证移植成功的关键因素。 Objective To investigate the method of excision and trimming of kidneys for kidneys and kidneys during liver-kidney resection. Methods From August 2012 to May 2013, 5 cases of neonatal cardiac death organ donation (DCD) were successfully completed for kidney transplantation in Jinan Military Region General Hospital. Among the 5 infants and young children, 4 were males and 1 was females. The median age was 9 months (0.5-27 months) and the median body mass was 10 kg (4-14 kg). The cause of death was craniocerebral trauma 4 cases and 1 case of drowning. The abdomen was cut by abdominal cross and the incision was made by unilateral common iliac artery and portal vein. , The perfusion pressure is about 80 cm H2O (1 cm H2O = 0.098 kPa); the liver and kidney are cut off jointly to separate the liver and kidney on the workbench and the donor kidney is trimmed. Among 5 adult recipients, 4 were males and 1 females, with a median age of 37 years (28-38 years) and a median body mass of 64 kg (44-68 kg). The primary disease was chronic glomerulonephritis. 4 patients received hemodialysis preoperatively, 1 patient received peritoneal dialysis, and the median time for dialysis was 17 months (6-30 months). Results All the 5 adult recipients received the first renal transplantation. The bilateral renal graft was used. The abdominal aorta and inferior vena cava were anastomosed with the iliac vessels. The anastomosis of the bladder flap and the ureter or ureter were anastomosed with the bladder. The median time for renal warm ischemia was 5 min (4 ~ 10 min), organ perfusion was good and no vascular injury was observed. The median time of cold ischemia was 6 h (5 ~ 10 h). One patient had a delayed recovery of graft function one month after operation, serum creatinine was maintained at 200 μmol / L, and serum creatinine returned to normal within 6-9 days in the remaining four patients, of which 1 case had graft kidney 32 days after operation Arterial rupture leads to death of the recipient. One patient had urinary leakage on the 14th postoperative day and resumed after the second operation. After 12 to 21 months of follow-up, 4 patients survived. Conclusion DCD for infants and young children is more difficult than that for adult donors. Correct nephrectomy, preservation and dressing are the key factors to ensure the success of transplantation.