器官移植
器官移植
기관이식
OGRAN TRANSPLANTATION
2014年
6期
356-359
,共4页
陈立中%王道虎%邱江%陈国栋%王长希
陳立中%王道虎%邱江%陳國棟%王長希
진립중%왕도호%구강%진국동%왕장희
肾移植,活体%活体供者%腹腔镜%供肾切取术%肾功能%生存质量
腎移植,活體%活體供者%腹腔鏡%供腎切取術%腎功能%生存質量
신이식,활체%활체공자%복강경%공신절취술%신공능%생존질량
Renal transplantation,living%Living donor%Laparoscopy%Donor nephrectomy%Renal function%Quality of life
目的：总结经腹膜后腹腔镜活体供肾切取的治疗经验。方法对2012年1月至2014年5月在中山大学附属第一医院采用经腹膜后腹腔镜活体供肾切取术的22例供者的临床资料进行回顾性分析。手术先采用纯腹腔镜手术方式分离输尿管、肾血管及肾周脂肪，然后采用腹股沟上内侧平行切口（利用腹侧穿刺口）为取肾切口，最后在手辅助下离断肾血管并取出肾脏。记录供者手术过程、术后随访情况。结果取右侧供肾1例，左侧供肾21例。22例手术过程顺利，均无中转开放手术，手术时间（123±31）min。取肾手术切口长度为（7.2±0.5）cm。术中出血15～80 ml，热缺血时间60～150 s。供肾的肾动脉长度为2.0～3.2 cm，肾静脉长度为1.0～3.5 cm。随访1～21个月，术后1 d、1周和1个月后的血清肌酐（Scr）水平分别为（120±57）、（95±25）、（90±21）μmol/L。22例供者中，术后并发肾窝血肿、伤口愈合不良各1例。术后1周供者疼痛评分0～5分，术后1个月0～1分。无供者感觉捐肾对总体健康有明显影响，1例供者觉得对体力有一定影响。结论在严格选择供体的情况下，开展经腹膜后腹腔镜活体供肾切取具有良好的安全性。由于其切口较小，术后疼痛程度轻，对供者的生存质量影响较小。
目的：總結經腹膜後腹腔鏡活體供腎切取的治療經驗。方法對2012年1月至2014年5月在中山大學附屬第一醫院採用經腹膜後腹腔鏡活體供腎切取術的22例供者的臨床資料進行迴顧性分析。手術先採用純腹腔鏡手術方式分離輸尿管、腎血管及腎週脂肪，然後採用腹股溝上內側平行切口（利用腹側穿刺口）為取腎切口，最後在手輔助下離斷腎血管併取齣腎髒。記錄供者手術過程、術後隨訪情況。結果取右側供腎1例，左側供腎21例。22例手術過程順利，均無中轉開放手術，手術時間（123±31）min。取腎手術切口長度為（7.2±0.5）cm。術中齣血15～80 ml，熱缺血時間60～150 s。供腎的腎動脈長度為2.0～3.2 cm，腎靜脈長度為1.0～3.5 cm。隨訪1～21箇月，術後1 d、1週和1箇月後的血清肌酐（Scr）水平分彆為（120±57）、（95±25）、（90±21）μmol/L。22例供者中，術後併髮腎窩血腫、傷口愈閤不良各1例。術後1週供者疼痛評分0～5分，術後1箇月0～1分。無供者感覺捐腎對總體健康有明顯影響，1例供者覺得對體力有一定影響。結論在嚴格選擇供體的情況下，開展經腹膜後腹腔鏡活體供腎切取具有良好的安全性。由于其切口較小，術後疼痛程度輕，對供者的生存質量影響較小。
목적：총결경복막후복강경활체공신절취적치료경험。방법대2012년1월지2014년5월재중산대학부속제일의원채용경복막후복강경활체공신절취술적22례공자적림상자료진행회고성분석。수술선채용순복강경수술방식분리수뇨관、신혈관급신주지방，연후채용복고구상내측평행절구（이용복측천자구）위취신절구，최후재수보조하리단신혈관병취출신장。기록공자수술과정、술후수방정황。결과취우측공신1례，좌측공신21례。22례수술과정순리，균무중전개방수술，수술시간（123±31）min。취신수술절구장도위（7.2±0.5）cm。술중출혈15～80 ml，열결혈시간60～150 s。공신적신동맥장도위2.0～3.2 cm，신정맥장도위1.0～3.5 cm。수방1～21개월，술후1 d、1주화1개월후적혈청기항（Scr）수평분별위（120±57）、（95±25）、（90±21）μmol/L。22례공자중，술후병발신와혈종、상구유합불량각1례。술후1주공자동통평분0～5분，술후1개월0～1분。무공자감각연신대총체건강유명현영향，1례공자각득대체력유일정영향。결론재엄격선택공체적정황하，개전경복막후복강경활체공신절취구유량호적안전성。유우기절구교소，술후동통정도경，대공자적생존질량영향교소。
Objective To summarize the experience of retroperitoneal laparoscopic living donor nephrectomy.Methods Clinical data of 22 donors undergoing retroperitoneal laparoscopic living donor nephrectomy in the First Affiliated Hospital of Sun Yat-sen University from January 201 2 to May 201 4 were analyzed retrospectively.The ureter,renal vessel and perirenal fat were dissected by laparoscopic approach.Then the renal vessels were cut off and the kidney was extracted by hand through superomedial inguinal parallel incision.The surgical process and the postoperative follow-up of the donors were recorded.Results One right kidney and 21 left kidneys were extracted.The operations in 22 cases were performed successfully without conversion to laparotomy.The operation time was (1 23 ±31 )min.The length of kidney extracting incision was (7.2 ±0.5)cm.The intraoperative blood loss was 1 5-80 ml and the warm ischemia time was 60-1 50 s.The length of donor renal arteries was 2.0-3.2 cm.The length of renal veins was 1 .0-3.5 cm.The donors were followed up for 1 -21 months.The serum creatinine (Scr)levels at 1 d,1 week and 1 month after operation were (1 20 ±57),(95 ±25),(90 ±21 )μmol/L respectively.Two cases suffered from renal fossa hematoma and poor wound healing after operation respectively.The pain score of the donors was 0-5 at 1 week after operation and 0-1 at 1 month after operation.No donor had the perception that donating kidney had obvious impacts on the general health,but 1 donor felt it had some influence on physical strength.Conclusions It is safe to perform retroperitoneal laparoscopic living donor nephrectomy on the basis of strict donor selection.It has little impacts on the donor's quality of life with small surgical incision and mild postoperative pain.
