CAJ | 학술논문

目的：研究腹股沟斜切口在后腹腔镜活体供肾切取术中应用的安全性和有效性。方法回顾性分析2008年5月至2012年3月在烟台毓璜顶医院泌尿外科行后腹腔镜活体供肾切取术的76例供者临床资料，根据供肾取出切口的不同将其分为两组，腹股沟切口组40例供者和腰部切口组36例供者分别采用腹股沟斜切口和腰部切口取出供肾。比较两组供者手术时间、术中出血量、供肾血管长度、住院时间、术后切口并发症发生情况和切口美容满意度。结果腹股沟切口组40例供者手术均成功；腰部切口组33例供者手术成功，3例因肾粘连和肾周脂肪组织较多改开放手术；两组均未发生死亡和严重并发症。两组手术时间和术中出血量差异均无统计学意义（P均＞0.01）。腹股沟切口组供肾热缺血时间为（1．6±1．2）min，短于腰部切口组，差异有统计学意义（t＝5．18，P＜0．01）。腹股沟切口组左、右侧供肾动脉血管长度分别为（2．6±0.4）cm和（3．7±0．3） cm，均长于腰部切口组；腹股沟切口组左、右侧供肾静脉血管长度分别为（3．50±0．40）cm和（1．70±0．23）cm，均长于腰部切口组，差异均有统计学意义（t＝4．75，7．32，76．3，6．45，P均＜0.01）。腹股沟切口组术后需接受镇痛治疗和腰腹部外观不对称的供者比例均低于腰部切口组，切口美容满意度高于腰部切口组，差异有统计学意义（χ2＝12．52，7．41，32.53，P均＜0．01）；腹股沟切口组无供者发生切口膨出，腰部切口组有6例供者发生切口膨出，两组比较差异有统计学意义（P＝0．009）。腹股沟切口组住院时间明显短于腰部切口组（t＝3.42，P＜0．01）。结论采用腹股沟斜切口的后腹腔镜活体供肾切取术能够提高手术安全性，保证最佳供肾血管长度，明显缩短供肾热缺血时间，减少切口并发症，提高供者切口美容满意度，值得临床推广。目的：研究腹股溝斜切口在後腹腔鏡活體供腎切取術中應用的安全性和有效性。方法迴顧性分析2008年5月至2012年3月在煙檯毓璜頂醫院泌尿外科行後腹腔鏡活體供腎切取術的76例供者臨床資料，根據供腎取齣切口的不同將其分為兩組，腹股溝切口組40例供者和腰部切口組36例供者分彆採用腹股溝斜切口和腰部切口取齣供腎。比較兩組供者手術時間、術中齣血量、供腎血管長度、住院時間、術後切口併髮癥髮生情況和切口美容滿意度。結果腹股溝切口組40例供者手術均成功；腰部切口組33例供者手術成功，3例因腎粘連和腎週脂肪組織較多改開放手術；兩組均未髮生死亡和嚴重併髮癥。兩組手術時間和術中齣血量差異均無統計學意義（P均＞0.01）。腹股溝切口組供腎熱缺血時間為（1．6±1．2）min，短于腰部切口組，差異有統計學意義（t＝5．18，P＜0．01）。腹股溝切口組左、右側供腎動脈血管長度分彆為（2．6±0.4）cm和（3．7±0．3） cm，均長于腰部切口組；腹股溝切口組左、右側供腎靜脈血管長度分彆為（3．50±0．40）cm和（1．70±0．23）cm，均長于腰部切口組，差異均有統計學意義（t＝4．75，7．32，76．3，6．45，P均＜0.01）。腹股溝切口組術後需接受鎮痛治療和腰腹部外觀不對稱的供者比例均低于腰部切口組，切口美容滿意度高于腰部切口組，差異有統計學意義（χ2＝12．52，7．41，32.53，P均＜0．01）；腹股溝切口組無供者髮生切口膨齣，腰部切口組有6例供者髮生切口膨齣，兩組比較差異有統計學意義（P＝0．009）。腹股溝切口組住院時間明顯短于腰部切口組（t＝3.42，P＜0．01）。結論採用腹股溝斜切口的後腹腔鏡活體供腎切取術能夠提高手術安全性，保證最佳供腎血管長度，明顯縮短供腎熱缺血時間，減少切口併髮癥，提高供者切口美容滿意度，值得臨床推廣。
목적：연구복고구사절구재후복강경활체공신절취술중응용적안전성화유효성。방법회고성분석2008년5월지2012년3월재연태육황정의원비뇨외과행후복강경활체공신절취술적76례공자림상자료，근거공신취출절구적불동장기분위량조，복고구절구조40례공자화요부절구조36례공자분별채용복고구사절구화요부절구취출공신。비교량조공자수술시간、술중출혈량、공신혈관장도、주원시간、술후절구병발증발생정황화절구미용만의도。결과복고구절구조40례공자수술균성공；요부절구조33례공자수술성공，3례인신점련화신주지방조직교다개개방수술；량조균미발생사망화엄중병발증。량조수술시간화술중출혈량차이균무통계학의의（P균＞0.01）。복고구절구조공신열결혈시간위（1．6±1．2）min，단우요부절구조，차이유통계학의의（t＝5．18，P＜0．01）。복고구절구조좌、우측공신동맥혈관장도분별위（2．6±0.4）cm화（3．7±0．3） cm，균장우요부절구조；복고구절구조좌、우측공신정맥혈관장도분별위（3．50±0．40）cm화（1．70±0．23）cm，균장우요부절구조，차이균유통계학의의（t＝4．75，7．32，76．3，6．45，P균＜0.01）。복고구절구조술후수접수진통치료화요복부외관불대칭적공자비례균저우요부절구조，절구미용만의도고우요부절구조，차이유통계학의의（χ2＝12．52，7．41，32.53，P균＜0．01）；복고구절구조무공자발생절구팽출，요부절구조유6례공자발생절구팽출，량조비교차이유통계학의의（P＝0．009）。복고구절구조주원시간명현단우요부절구조（t＝3.42，P＜0．01）。결론채용복고구사절구적후복강경활체공신절취술능구제고수술안전성，보증최가공신혈관장도，명현축단공신열결혈시간，감소절구병발증，제고공자절구미용만의도，치득림상추엄。
Objective To evaluate the safety and effectiveness of inguinal incision in retroperitoneal laparoscopic living donor nephrectomy .Methods The clinical data of76 donors who underwent retroperitoneal laparoscopic living donor nephrectomies in Yantai Yuhuangding Hospital from May 2008 to March 2012 were retrospectively analyzed .They were divided into the observation group who adopted inguinal incision to exteriorize kidney ( n=40) , and the control group who adopted lumbar incision to exteriorize kidney ( n =36 ). Operation time, blood loss, renal vascular length, hospitalization time, incision complications and cosmetic satisfaction were compared between 2 groups. Results All 40 cases of the observation group and 33 cases of the control group operations were successful , 3 cases of the control group were converted to open operation due to kidney adhesion or peripheral adipose tissue , without death and serious complications .There were no differences in mean operation time and blood loss between 2 groups.The ischemic time were (1.6 ±1.2) min and (3.3 ± 1.6) min in the observation group and the control group (t=5.18, P<0.01) respectively.The artery length of left and right donor kidney were (2.6 ±0.4) cm vs (2.2 ±0.3) cm (t=4.75, P<0.01) and (3.7 ±0.3) cm vs (3.1 ±0.4) cm (t=7.32, P<0.01) in the observation group and the control group, respectively.The vein length of left and right donor kidney were (3.50 ±0.40) cm vs (2.90 ± 0.23) cm (t=7.63, P<0.001) and (1.70 ±0.23) cm vs (1.30 ±0.30) cm (t=6.45, P<0.01) in the observation group and the control group , respectively .The proportion of undergoing analgesic treatment and the incidence of waist and abdomen asymmetry were 2.5%(1/40) vs 33.3%(11/33) and 2.5% (1/40) vs 27.3% (9/33) in the observation group and the control group , respectively, with statistically significant differences (χ2 =12.52, 7.41, all P<0.01). The incidence of incision bulging were 0 vs18 .2% (6/33) in the observation group and the control group (P =0.009), respectively.Mean hospitalization time of the observation group and the control group were (5.3 ±2.4) d and (7.5 ±3.1) d (t=3.42, P<0.01).Cosmetic satisfaction of the observation group was 80%(32/40), higher than that of the control group (15.2%, 5/33), with a statistically significant difference (χ2 =32.53, P<0.01).Conclusions The inguinal incision in retroperitoneal laparoscopic living donor nephrectomy can improve the safety of operation , ensure the vascular length of donor kidney , shorten graft warm ischemia time , decrease incision complications and improve cosmetic satisfaction, and be worthy to be applied in clinic .