泌尿外科杂志（电子版）
泌尿外科雜誌（電子版）
비뇨외과잡지（전자판）
JOURNAL OF UROLOGY FOR CLINICIAN(ELECTRONIC VERSION)
2013年
3期
15-19
,共5页
门昌平%张丽英%王科%林春华%吴吉涛%于胜强%杨典东%高振利
門昌平%張麗英%王科%林春華%吳吉濤%于勝彊%楊典東%高振利
문창평%장려영%왕과%림춘화%오길도%우성강%양전동%고진리
腹股沟切口%后腹腔镜%活体供肾
腹股溝切口%後腹腔鏡%活體供腎
복고구절구%후복강경%활체공신
retroperitoneal laparoscopy%living donor nephrectomy%inguinal oblique incision
目的：研究腹股沟切口在后腹腔镜活体供肾切取术的安全性和有效性。方法选择本院2008年5月至2013年4月进行的79例后腹腔镜活体供肾切取术，根据手术标本取出切口的不同分为试验组和对照组，试验组（ n＝40）采用腹股沟切口取出供肾，对照组（ n＝36）采用腰部切口取出供肾；其余3例因肾脏粘连和肾周脂肪组织较多术中改开放手术，从对照组中剔除。两组左右侧供肾分别为35/5和32/4。对两组手术时间、术中出血量、供肾热缺血时间、供肾血管长度、患者住院时间、切口并发症、切口美容满意度进行比较。结果实验组以及对照组手术均全部成功，无死亡和重大并发症。实验组和对照组在手术时间、术中出血量差别无统计学意义。两组的供肾热缺血时间分别为（1．6±1．2）分钟对（3．3±1．6）分钟（P＜0．0001）；两组的左右侧供肾动脉血管长度分别为（2．6±0．4）cm对（2．2±0．3）cm（P＜0．0001）和（3．7±0．3）cm对（3．1±0．4）cm（P＜0．0001）；两组的左右侧供肾静脉血管长度分别为（3．5±0．4）cm对（2．9±0．23）cm（P＜0．0001）和（1．7±0．23）cm对（1．3±0．3）cm（P＜0．0001）；两组术后镇痛治疗、切口膨出、腰腹部不对称病例分别为1例和11例（P＝0．001）、0例和6例（P＝0．009）、1例和9例（P＝0．005）；住院时间分别为（5．3±2．4）天和（7．5±3．1）天（P＝0．0008）；差别有统计学意义。切口美容满意度（Ⅰ/Ⅱ/Ⅲ）分别为1/7/32和14/16/6（ P＜0．0001），实验组切口美容满意度高于对照组。结论腹股沟切口在后腹腔镜活体供肾切取术应用能够提高供肾切取的安全性，避免开放手术，保证供肾血管长度，缩短供肾热缺血时间，减少切口并发症，缩短供者住院时间，提高供者切口美容满意度，值得临床推广应用。
目的：研究腹股溝切口在後腹腔鏡活體供腎切取術的安全性和有效性。方法選擇本院2008年5月至2013年4月進行的79例後腹腔鏡活體供腎切取術，根據手術標本取齣切口的不同分為試驗組和對照組，試驗組（ n＝40）採用腹股溝切口取齣供腎，對照組（ n＝36）採用腰部切口取齣供腎；其餘3例因腎髒粘連和腎週脂肪組織較多術中改開放手術，從對照組中剔除。兩組左右側供腎分彆為35/5和32/4。對兩組手術時間、術中齣血量、供腎熱缺血時間、供腎血管長度、患者住院時間、切口併髮癥、切口美容滿意度進行比較。結果實驗組以及對照組手術均全部成功，無死亡和重大併髮癥。實驗組和對照組在手術時間、術中齣血量差彆無統計學意義。兩組的供腎熱缺血時間分彆為（1．6±1．2）分鐘對（3．3±1．6）分鐘（P＜0．0001）；兩組的左右側供腎動脈血管長度分彆為（2．6±0．4）cm對（2．2±0．3）cm（P＜0．0001）和（3．7±0．3）cm對（3．1±0．4）cm（P＜0．0001）；兩組的左右側供腎靜脈血管長度分彆為（3．5±0．4）cm對（2．9±0．23）cm（P＜0．0001）和（1．7±0．23）cm對（1．3±0．3）cm（P＜0．0001）；兩組術後鎮痛治療、切口膨齣、腰腹部不對稱病例分彆為1例和11例（P＝0．001）、0例和6例（P＝0．009）、1例和9例（P＝0．005）；住院時間分彆為（5．3±2．4）天和（7．5±3．1）天（P＝0．0008）；差彆有統計學意義。切口美容滿意度（Ⅰ/Ⅱ/Ⅲ）分彆為1/7/32和14/16/6（ P＜0．0001），實驗組切口美容滿意度高于對照組。結論腹股溝切口在後腹腔鏡活體供腎切取術應用能夠提高供腎切取的安全性，避免開放手術，保證供腎血管長度，縮短供腎熱缺血時間，減少切口併髮癥，縮短供者住院時間，提高供者切口美容滿意度，值得臨床推廣應用。
목적：연구복고구절구재후복강경활체공신절취술적안전성화유효성。방법선택본원2008년5월지2013년4월진행적79례후복강경활체공신절취술，근거수술표본취출절구적불동분위시험조화대조조，시험조（ n＝40）채용복고구절구취출공신，대조조（ n＝36）채용요부절구취출공신；기여3례인신장점련화신주지방조직교다술중개개방수술，종대조조중척제。량조좌우측공신분별위35/5화32/4。대량조수술시간、술중출혈량、공신열결혈시간、공신혈관장도、환자주원시간、절구병발증、절구미용만의도진행비교。결과실험조이급대조조수술균전부성공，무사망화중대병발증。실험조화대조조재수술시간、술중출혈량차별무통계학의의。량조적공신열결혈시간분별위（1．6±1．2）분종대（3．3±1．6）분종（P＜0．0001）；량조적좌우측공신동맥혈관장도분별위（2．6±0．4）cm대（2．2±0．3）cm（P＜0．0001）화（3．7±0．3）cm대（3．1±0．4）cm（P＜0．0001）；량조적좌우측공신정맥혈관장도분별위（3．5±0．4）cm대（2．9±0．23）cm（P＜0．0001）화（1．7±0．23）cm대（1．3±0．3）cm（P＜0．0001）；량조술후진통치료、절구팽출、요복부불대칭병례분별위1례화11례（P＝0．001）、0례화6례（P＝0．009）、1례화9례（P＝0．005）；주원시간분별위（5．3±2．4）천화（7．5±3．1）천（P＝0．0008）；차별유통계학의의。절구미용만의도（Ⅰ/Ⅱ/Ⅲ）분별위1/7/32화14/16/6（ P＜0．0001），실험조절구미용만의도고우대조조。결론복고구절구재후복강경활체공신절취술응용능구제고공신절취적안전성，피면개방수술，보증공신혈관장도，축단공신열결혈시간，감소절구병발증，축단공자주원시간，제고공자절구미용만의도，치득림상추엄응용。
Objectives Evaluate the safety and effectiveness of inguinal incision application in retroperitoneal lapa -roscopic living donor nephrectomy .Methods From May 2008 to April 2013, 79 cases of retroperitoneal laparo-scopic living donor nephrectomies were selected in our hospital .All data were analysed retrospectively .All cases were grouped as test group( n=40, inguinal incision) and control group( n=36, lumbar incision) according to kidney retrieval incision .The rest of the 3 cases were converted to open operation for renal adhesion and perire-nal hyperliposis , and they were excluded from the control group .The left and right donor kidney were respective-ly 35/5 and 32/4 in two groups .Operation time , warm ischemia time , operation blood loss , kidney vessel length, hospital stay , incision complications and cosmetic satisfaction were compared .Results All 40 cases of test group and 36 cases of control group were successfully accomplished , without death and serious complica-tions.There were no differences in mean operation time and blood loss between two groups .The warm ischemia time were (1.6 ±1.2)min and (3.3 ±1.6)min, (P<0.0001).The artery length of left and right donor kid-ney were respectively (2.6 ±0.4)cm and (2.2 ±0.3)cm (P<0.0001), (3.7 ±0.33)cm and (3.1 ±0.4) cm (P<0.0001) in two groups.The vein length were respectively (3.5 ±0.4)cm and (2.9 ±0.23)cm(P<0.0001 ), (1.7 ±0.23)cm and (1.3 ±0.3)cm, (P<0.0001).Postoperative pain therapy, incision pro-lapse, waist and abdomen asymmetry were respectively 1 and 11(P =0.001), 0 and 6(P =0.001), 1 and 9 (P =0.005).Mean hospital stay were (5.3 ±2.4)d and (7.5 ±3.1)d (P =0.0008).Cosmetic satisfac-tion (Ⅰ/Ⅱ/Ⅲ) were 1/7/32 and 14/16/6 (P<0.0001), cosmetic satisfaction of test group was higher than that of control group .Conclusions Inguinal incision application in retroperitoneal laparoscopic living donor ne-phrectomy could decrease the warm ischemia time , avoid to change open surgery , guarantee the vessel length of donor kidney , increase the safety of the donor and the quality of donor kidney , offer advantage of less complica-tions and higher cosmetic satisfaction , It should be applied generally .
