中华器官移植杂志
中華器官移植雜誌
중화기관이식잡지
CHINESE JOURNAL OF ORGAN TRANSPLANTATION
2012年
10期
590-593
,共4页
蔡明%许亮%王强%李州利%金海龙%詹胜利%王爽%韦星%李聪然%石炳毅
蔡明%許亮%王彊%李州利%金海龍%詹勝利%王爽%韋星%李聰然%石炳毅
채명%허량%왕강%리주리%금해룡%첨성리%왕상%위성%리총연%석병의
肾移植%活体供者%腹腔镜%肾动脉%Hem-o-lock
腎移植%活體供者%腹腔鏡%腎動脈%Hem-o-lock
신이식%활체공자%복강경%신동맥%Hem-o-lock
Kidney transplantation%Living donors%Laparoscopes%Renal artery%Hem-o-lock
目的 对经腹膜后入路腹腔镜活体供肾切取术(LDN)中肾动脉的结扎方式进行分析总结.方法 2003年6月至2012年6月共实施亲属活体肾移植术211例,其中2007年以后136例供肾切取均采用经腹膜后入路的腹腔镜活体供肾切取手术.在LDN肾动脉结扎中,采取开放Hem-o-lock夹结扎40例,腹腔镜下Hem-o-lock夹结扎87例,腹腔镜下ENDO-GIA结扎5例,腹腔镜下Hem-o-lock夹结扎联合手辅助丝线缝扎4例.结果 开放行Hem-o-lock夹结扎方式供肾热缺血时间最短,为(1.1±0.3) min,腹腔镜下Hem-o-lock夹结扎方式供肾热缺血时间最长,为(3.2±0.8)min,开放组与其他各组相比,供肾热缺血时间的差异均有统计学意义(P＜0.05).在移植肾预后各因素的比较中,各组无明显差异.腹腔镜下单纯Hem-o-lock夹结扎中出现Hem-o-lock夹致肾动脉破裂1例,经紧急转为开放手术,持续输血和自体回输并积极维持生命体征等应急措施,供者最终于术成功,顺利出院.其余结扎方式均安全可靠,未出现不良反应.结论 LDN中,开放行Hem-o-lock夹结扎方式的供肾热缺血时间最短,而腹腔镜下Endo-GIA结扎方式和Hem-o-lock夹联合手辅助丝线缝扎方式最为安全可靠 ;针对供肾可疑有严重动脉粥样硬化等高危人群的LDN,Hem-o-lock夹对肾动脉的结扎需谨慎.
目的 對經腹膜後入路腹腔鏡活體供腎切取術(LDN)中腎動脈的結扎方式進行分析總結.方法 2003年6月至2012年6月共實施親屬活體腎移植術211例,其中2007年以後136例供腎切取均採用經腹膜後入路的腹腔鏡活體供腎切取手術.在LDN腎動脈結扎中,採取開放Hem-o-lock夾結扎40例,腹腔鏡下Hem-o-lock夾結扎87例,腹腔鏡下ENDO-GIA結扎5例,腹腔鏡下Hem-o-lock夾結扎聯閤手輔助絲線縫扎4例.結果 開放行Hem-o-lock夾結扎方式供腎熱缺血時間最短,為(1.1±0.3) min,腹腔鏡下Hem-o-lock夾結扎方式供腎熱缺血時間最長,為(3.2±0.8)min,開放組與其他各組相比,供腎熱缺血時間的差異均有統計學意義(P＜0.05).在移植腎預後各因素的比較中,各組無明顯差異.腹腔鏡下單純Hem-o-lock夾結扎中齣現Hem-o-lock夾緻腎動脈破裂1例,經緊急轉為開放手術,持續輸血和自體迴輸併積極維持生命體徵等應急措施,供者最終于術成功,順利齣院.其餘結扎方式均安全可靠,未齣現不良反應.結論 LDN中,開放行Hem-o-lock夾結扎方式的供腎熱缺血時間最短,而腹腔鏡下Endo-GIA結扎方式和Hem-o-lock夾聯閤手輔助絲線縫扎方式最為安全可靠 ;針對供腎可疑有嚴重動脈粥樣硬化等高危人群的LDN,Hem-o-lock夾對腎動脈的結扎需謹慎.
목적 대경복막후입로복강경활체공신절취술(LDN)중신동맥적결찰방식진행분석총결.방법 2003년6월지2012년6월공실시친속활체신이식술211례,기중2007년이후136례공신절취균채용경복막후입로적복강경활체공신절취수술.재LDN신동맥결찰중,채취개방Hem-o-lock협결찰40례,복강경하Hem-o-lock협결찰87례,복강경하ENDO-GIA결찰5례,복강경하Hem-o-lock협결찰연합수보조사선봉찰4례.결과 개방행Hem-o-lock협결찰방식공신열결혈시간최단,위(1.1±0.3) min,복강경하Hem-o-lock협결찰방식공신열결혈시간최장,위(3.2±0.8)min,개방조여기타각조상비,공신열결혈시간적차이균유통계학의의(P＜0.05).재이식신예후각인소적비교중,각조무명현차이.복강경하단순Hem-o-lock협결찰중출현Hem-o-lock협치신동맥파렬1례,경긴급전위개방수술,지속수혈화자체회수병적겁유지생명체정등응급조시,공자최종우술성공,순리출원.기여결찰방식균안전가고,미출현불량반응.결론 LDN중,개방행Hem-o-lock협결찰방식적공신열결혈시간최단,이복강경하Endo-GIA결찰방식화Hem-o-lock협연합수보조사선봉찰방식최위안전가고 ;침대공신가의유엄중동맥죽양경화등고위인군적LDN,Hem-o-lock협대신동맥적결찰수근신.
Objective To analyze the clinical techniques of renal artery control in laparoscopic donor nephrectomy.Methods 211 relative living renal transplantations were performed from June 2003 to June 2012,and 136 donors underwent laparoscopic donor living nephrectomy (LDN) since 2007.Forty donors were subjected to the Hem-o-lock clips for renal artery control by open surgery,87 donors to the Hem-o-lock clips for renal artery control by laparoscope,5 donors to the Endo GIA stapler for renal artery control by laparoscope,and 4 donors to the Hem-o-lock clips by laparoscope combined with hand-assisted suture transfixion for renal artery control.Results The warm ischemia time of renal artery control was shortest (1.1 ± 0.3 min) by Hem-o-lock clips in open surgery,and longest (3.2 ± 0.8) min by the Hem-o-lock clips with laparoscope.There was significant difference in the warm ischemia time of renal artery between open group and other groups,the differences (P＜0.05).The comparison of prognostic factors in the transplant renal outcome showed no significant difference among groups.The renal arterial stump-rrhexis-caused massive secondary bleeding occurred in 1 case subject to Hem-o-lock clips for renal artery control by laparoscope,with conversion to open surgery urgently,the operation was successful at last.Other renal artery control ways were all safe without any adverse reaction.Conclusion The warm ischemia time of renal artery control by Hem-o-lock clips in open surgery was shortest in laparoscopic donor nephrectomy.The renal artery control way by Endo GIA stapler in laparoscope or by Hem-o-lock clips with hand-assisted suture transfixion is safest.The utilization of Hem-o-lock clips should be careful in high risk population such as severe atherosclerosis etc.
