手辅助腹腔镜在亲属活体供肾切取中的应用25例报告

目的 探讨手辅助腹腔镜在亲属活体供肾切取中的应用.方法 回顾性分析25名亲属活体供肾者的资料.25名供者中,男性6名,女性19名,年龄(42±17)岁.23例为亲属血缘关系供肾,2例为夫妻间供肾.分析供者选择手辅助腹腔镜下取肾术的原因、供者的手术时间、供肾热缺血时间、术中出血量、肾脏及周围脏器损伤情况、术后恢复情况及移植肾功能恢复情况,评价手辅助腹腔镜下取肾术的临床应用效果.结果 对25名亲属供者应用手辅助腹腔镜下取肾术均获成功,无中转开放手术;24例取左肾,1例取右肾;手术时间(138±42)min,供肾热缺血时间为(145±22)s,术中出血量(53±32)m1;无供肾损伤,无切口相关并发症,仅有1例发生脾包膜撕裂;术后住院时间为(7.2±1.7)d,供者均满意.调查显示,供者选择手辅助腹腔镜下取肾术的主要原因是手术损伤小、切口对外观影响较小、心理负担轻.亲属活体供肾移植后,仅有1例受者发生移植肾功能恢复延迟,其余受者的血肌酐水平均在1周内下降至正常.结论 手辅助腹腔镜下取肾术综合了传统腹腔镜技术和开放性手术取肾的优点,微创,操作方便,供肾损伤机会少,切口对外观影响较小,供者易于接受.

Hand-assisted laparoscopic living donor nephrectomy in living renal transplantation

OBjective To evaluate the efficiency of hand-assisted laparoscopic technique for living donor nephrectomy in renal transplantation. Methods A total of 25 cases of living related kidney donors undergoing hand-assisted laparoscopic living donor nephrectomy (HLDN) were retrospectively analyzed. Of the 25 donors, with age of 42±17 years, 6 males and 19 females, 23 cases were livingrelated donors and the rest 2 spouse. Operative time, blood loss, warm ischemia time, renal or other organ injury during operation, the donors' postoperative hospital stay, the reasons to choose HLDN,and the function of the allograft were analyzed. Results The procedure was performed successfully in all 25 donors, and there was no conversion to open operation. Twenty-four cases received left side nephrectomy, and 1 case right. The mean operative time was 138±42 min, estimated blood loss 53±32 ml, and warm ischemia time 145±22 s. No renal injury occurred and there was one case of spleen injury during operation. No complications about incision occurred. The donors' postoperative hospital stay was 7.2±1.7 days. The main reasons to choose HLDN included less postoperative pain and cosmetic concerns. The recipient had normal renal function at the first week postoperation except one case who had delayed graft function. Conclusion HLDN combined the advantages of pure laparoscopic living donor nephrectomy and open donor nephrectomy. It is not only minimally invasive, safe, and fine cosmetic for donor, but also convenient in operation, and has no injury on allgraft. HLDN may be the first selective method for living donor nephrectomy in living renal transplantation in the future.