| Section 1 Enhanced recovery after pediatric kidney transplantation with a super-minimal incision techniqueObjectiveTo investigate the effect of super-minor Incision Kidney Transplantation(SMIPKT)in postoperative rehabilitation.MethodA prospective matched control design was used.The left and right kidneys of children donors who were donated by organs after the death of the same citizen were assigned to two patients in the center by digital random method.SMIKPT was performed in the experimental group,and CIKT was performed in the control group.The indicators were compared to explore the effect of SMIPKT in postoperative rehabilitation.Result24 children who underwent kidney transplantation in our hospital were enrolled in this study from December 2018 to October 2020.They were equally divided into experimental group SMIKPT and control group CIKT.Compared with cikt group,smipkt group had shorter operation time(132.58 ± 18.97 min vs 183.00±57.28 min,P=0.003),shorter incision length(4.46 ± 0.63 cm vs 12.08±2.18 cm,P<0.01),less intraoperative blood loss(44.58 ± 10.70 ml vs 107.50 ± 56.88 ml).Compared with cikt group,smipkt group had less wound drainage fluid(111.25 ±68.71ml vs 287.50±180.36ml,P<0.05),The results showed that the drainage tube could be removed in a shorter time(3.83 ± 1.07 days vs 6.58 ± 3.75 days,P=0.005);and the hospital stays was shorter(22.08±17.21 vs 30.83 ± 19.06 days,P=0.011).One month after operation,the wound healing was better(6.00 ± 0.63 vs 6.82 ± 0.75,P=0.012).ConclusionCompared with traditional incision renal transplantation in children,smipkt has less operation time and bleeding,earlier drainage tube removal,and less average cost.Section 2 Analyze the effect of end-to-end anastomosis of internal iliac artery after renal transplantation in childrenObjectiveObjective to explore the effect of end-to-end anastomosis of internal iliac artery in pediatric renal transplantation.MethodIn this study,retrospective analysis was used to analyze the children who received kidney transplantation in our hospital from August 2012 to April 2020,and the donors were also children.We should find out the patients who received end-to-end anastomosis of internal iliac artery and regular color Doppler ultrasound examination of transplanted kidney,and analyze the indicators of 6 months,1 year,2 years,3 years and 5 years after kidney transplantation,so as to evaluate the recovery of transplanted kidney and patients.ResultThe 6-month,1-year,3-year and 5-year survival rates of transplanted kidneys/recipients were 97.70%/98.50%,96.20%/97.00%,91.70%/96.20%and 91.00%/95.50%.In dialysis mode,significantly difference were not found in time and gender each time point.At the same time,there were 20 children under 6 years old,48 children between 6 and 12 years old,and 65 children over 12 years old.By pairwise comparison,children under 6 years old were better than children over 12 years old at each time point,and children between 6 and 12 years old were also better than children over 12 years old in the preliminary stage,but there was no difference in latterly.The increase of renal diameter and internal iliac artery diameter was 14.63±7.07 mm and 0.66±0.28 mm at 1 year after operation,which was statistically significant with the increase of renal diameter and internal iliac artery diameter at 2 and 3 years after operation.In the patients less than 10 years old and more than 10 years old,the increase of renal long diameter was 16.93±6.34 mm and 13.05 ±7.12mm respectively,which was statistically significant.The increase of internal iliac artery diameter was 0.75±0.26,0.59±0.27mm and 0.33 ± 0.13,0.22±0.08 mm in the first and second year after operation,respectively.ConclusionThe end-to-end anastomosis of internal iliac artery in children’s kidney transplantation has better recovery and human/kidney survival in the medium and long term.The graft function of younger children is better in latterly,and the graft kidney and renal artery grow faster in the short term.SummaryThis study found that:1.Compared with the traditional incision method of renal transplantation in children,smipkt can obtain shorter operation time and less bleeding,remove the drainage tube earlier,so as to obtain shorter average hospital stay,which is conducive to faster recovery of children after transplantation.2.The end-to-end anastomosis of internal iliac artery in children’s kidney transplantation has better human/kidney survival in the medium and long term.The graft function of younger children is better in latterly,and the graft kidney and renal artery grow faster in the short term. |
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