摘要
目的 探讨采用微创技术进行供肾切取的最佳手术方式和手术路径.方法 回顾性分析我院2013年9月至2015年12月68例行微创供肾切取手术供者的临床资料.按手术方式分为机器人辅助腹腔镜下供肾切取术(机器人组)31例、完全后腹腔镜下供肾切取术(非手助组)29例和手助后腹腔镜下供肾切取术(手助组)8例,比较3组的手术时间、热缺血时间、术中出血量、住院时间、并发症及受者手术前后血肌酐值.结果 3组手术均顺利完成.机器人组、非手助组和手助组的术中出血量分别为(39±15)、(62±37)、(53±19)ml,差异有统计学意义(P<0.05);住院时间分别为(4.6±1.0)、(5.4±1.5)、(5.2±1.2)d,差异无统计学意义(P>0.05).3组的平均手术时间、热缺血时间及并发症发生率比较差异均无统计学意义(均P>0.05).机器人组早期2例供者术中出现脾脏损伤,行脾脏修补术;1例出现术后出血,输血后痊愈.非手助组1例术后发生泌尿系感染,予抗感染治疗后治愈;1例术后第6天发生髂外静脉血栓,行下腔静脉滤器植入术后缓解.手助组1例术后发生伤口脂肪液化,愈合延迟.3组供者随访时间均>9个月,均无高血压、蛋白尿、肾功能异常等并发症发生.机器人组、非手助组和手助组受者术后第5天复查血肌酐分别为(118±23)、(130±33)、(128±41)μmol/L,第28天复查血肌酐分别为(114±17)、(116±34)、(115±29)μmol/L,差异均无统计学意义(均P>0.05).结论 采用微创技术行供肾切取有利于供者恢复,术者应结合个人经验和所在医院的条件等因素,以供者安全、兼顾供受者利益为原则,选择自己最熟练的术式.
Objective To discuss the optimal operation mode and operation path in minimally invasive technique for living donor nephrectomy.Methods From September 2013 to August 2015, 68 living donor nephrectomy was retrospectively reviewed. Thirty-one patients were performed with robotic-assisted laparoscopic living donor nephrectomy(robotic group), twenty-nine patients underwent totally retroperitoneal laparoscopic living donor nephrectomy(non hand assisted group),and eight patients were performed with hand assisted retroperitoneal laparoscopic living donor nephrectomy(hand assisted group). Operation time, warm ischemia time, intraoperative hemorrhage volume, hospitalization time, complications and preoperative and postoperative serum creatinine value of the recipients between the two groups were compared.Results The operations of three groups were all performed successfully. Intraoperative hemorrhage volume in the three groups were(39±15)ml,(62±37)ml and(53±19)ml, and there were significant differences between these groups(P<0.05). But hospitalization time ,operation time, warm ischemia time and complications occurred rate in the three groups had no significant difference(P>0.05). In robotic group,2 donors occurred with splenic injury during operation and 1 donor was detected with hemorrhage after operation. In non-hand assisted group, 1 donor occurred with urinary tract infection, 1 donor occurred with external iliac vein thrombosis. In hand assisted group 1 donor was detected with wound fat liquefaction after operation. All the donors were followed up for more than 9 months, no hypertension, proteinuria and renal dysfunction complications were detected. The blood creatinine in three groups of recipients after operation of 5th day and 28th day were(118±26)μmol/L, (130±33)μmol/L,(128±41)μmol/L and(114±17)μmol/L,(116±34)μmol/L,(115±29)μmol/L, respectively, and there was no statistical difference(P>0.05).Conclusions Minimally invasive technique for living donor nephrectomy is beneficial to patients' recovery.
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2017年第S1期49-53,共5页
Chinese Journal of Urology
关键词
肾移植
供肾切取
机器人辅助腹腔镜
后腹腔镜
Kidney transplantation
Living donor nephrectomy
Robot assisted laparoscopy
Retroperitoneal laparoscopy
