摘要
目的 总结后腹腔镜下亲属活体左侧供肾切取术35例的经验. 方法 回顾性分析2011年11月至2013年2月35例后腹腔镜下亲属活体左侧供肾切取术的资料.常规取腰部3个穿刺点入路,在肾脂肪囊内游离肾脏后,游离输尿管至跨髂血管处剪断.肾脏及动静脉完全游离,自腋前线肋缘下切口向脐部方向延长5～6 cm,术者左手进入握住肾脏,用Hem-o-lok夹闭肾动脉和肾静脉后剪断,立即取出肾脏,交台下灌注. 结果 35例手术经过顺利,无中转开放.左肾动脉多支8例,其中两支6例,三支2例.手术时间70～186 min,平均（98±25） min.热缺血时间1.8～4.5 min,平均（2.7±0.8） min.出血20～350 ml,平均（65±30）ml.均未输血.发生手术并发症3例,1例淋巴瘘短期自愈,腰静脉损伤出血1例,被膜下血肿1例,均无不良影响.术后住院时间5～10d,平均（6.5±1.5）d.35例供者随访1～15个月,平均7个月,均健康.35例受者中仅1例发生移植肾功能延迟恢复,3周后肾功能恢复正常;余34例肾功能均于2周内恢复正常. 结论 后腹腔镜下亲属活体供肾切取术安全可靠,可替代传统开放取肾手术.
Objective To report our experience of 35 retroperitoneal laparoscopic left living-related donor nephrectomies.Methods A total of 35 related donors underwent retroperitoneal laparoscopic living donor nephrectomy from November 2011 to February 2013.The operation was performed through 3 lumbar ports.After the kidney was liberated fully and the ureter was severed 7-8 cm under the lower pole of kidney,a 5-6 cm incision was made below the rib,from the anterior auxiliary line to the umbilical.The left hand of the operator held the kidney and vessels,renal artery and vein were blocked with Hem-o-lok separately and then severed.Then the kidney was taken out quickly from the donor and infused immediately.Results The 35 cases accepted the operation successfully.Two kidneys had 3 arteries,and 6 had 2 arteries.The mean operative time was （98±25） min （70-186 min）.Warm ischemia time was （2.7±0.8） min （1.8-4.5 min）.And the estimated blood loss was （65±30） ml （20-350 ml）.No patient needed blood transfusion.Complications appeared in 3 cases,including lumbar vein injury in 1 patient,hematoma of renal subcapsule in 1 patient and short term lymphatic leakage in 1 patient.No further treatment was required.Hospital stay after operation was （6.5±1.5） d.All the 35 donors were followed up for 7 （1-15） months,and all of them were healthy.One recipient showed delayed graft function recovery,whose level of creatinine declined to normal within 3 weeks.And the level of creatinine declined to normal within 2 weeks in the other 34 recipients.Conclusion Retroperitoneal laparoscopic living relatives donor nephrectomy is a safe and reliable procedure,which can replace the traditional open surgery.
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2014年第1期24-27,共4页
Chinese Journal of Urology
关键词
腹腔镜
定向组织捐赠
活体供肾
肾切除术
肾移植
Laparoscopes
Directed tissue donation
Living donor
Nephrectomy
Kidney transplantation
