腹腔镜活体供肾切取术(附16例报告)

目的 总结腹腔镜活体供肾切取技术。方法 对16例腹腔镜活体供肾切取术资料进行分析。活体供。肾者16例，男7例，女9例，年龄36～53岁，平均46岁，均为左侧供。肾。受者原发病均为慢性肾小球肾炎。供受者血型相同，淋巴细胞毒性试验均为阴性。结果 手术成功15例，1例因术中出血改开放手术。手术时间3．1～5．2h，出血56～270ml，平均热缺血时间3．5min，住院时间9～12d。16例受者中移植。肾功能延迟恢复1例，术后第5周移植肾功能恢复正常；余15例受者血清肌酐均在10d内降至正常（SCr〈146μmol／L），其中出现急性排斥反应1例，应用激素冲击治疗后逆转。结论 腹腔镜活体供肾切取手术损伤小，术后恢复快，不影响肾功能。     

手助腹腔镜活体供肾摘取术在肾移植中的应用

目的 为减轻对话体供者的损伤，探讨腹腔镜在供肾切取中的应用。方法 对3名亲属活体供肾者采用腹腔镜切取肾脏，术前行磁共振、静脉尿路造影和数字减影血管造影检查，以了解供者双侧肾脏的血管情况，取肾术在全身麻醉下进行，先行腹腔穿刺，注入CO2气体，以形成气腹，供肾通过脐上腹中线切口取出。结果 2例取左肾，l例取右肾，3例取肾手术均获成功，手术历时5、4和3．5h，失血100～400ml，供肾热缺血时间分别为8、5、5min，血管吻合完毕开放血流后，移植肾均在1min内泌尿，移植肾功能良好。结论 活体供者采用腹腔镜取肾可减轻供者的手术创伤，术后伤口疼痛轻，住院时间短，身体恢复快。     

无气腹悬吊腹腔镜活体供者取肾术与开放手术的比较

目的：评价无气腹悬吊腹腔镜活体供者取肾手术（SGLLDN）的临床价值。方法：比较40例SGLLDN和32例开放活体供者取肾手术（OLDN）的临床效果。结果：SGLLDN组39例成功,转开放手术1例;OLDN组32例全部成功。SGLLDN与OLDN相比,切口长度较短,（8.0±2.3）cm vs（19.5±3.5）cm（P〈0.01）;手术时间较长,（120.1±16.2）min vs（60.5±12.1）min（P〈0.05）;术中出血量较少,（158.5±45.3）mL vs（289.2±65.1）mL（P〈0.01）;住院时间较短,分别（5.0±1.0）d vs（9.0±2.0）d（P〈0.05）;术中供肾热缺血时间和术后肾功能恢复正常时间二者差异无统计学意义（P〉0.05）。结论：与OLDN相比,SGLDN具有切口创伤小、出血少、患者恢复快、住院时间短等优点。缺点是手术时间稍长、费用稍贵。临床可根据不同供者要求选择不同手术方法。     

腹腔镜与开放手术活体取肾供者1年随访研究

目的 比较腹腔镜活体取肾(LDN)与开放手术活体取肾(ODN)的手术安全性及供者术后1年肾功能及血压状况. 方法LDN和ODN各30例,比较2组手术时间、热缺血时间、术中失血量、术后开始进食时间及术后开始下床活动时间,并根据改良Clavien分级系统统计2组围手术期并发症情况.对2组供者术前及术后第1天、1周、3、6个月、1年的血肌酐、血压、24 h尿蛋白定量水平和术前及术后6个月、1年时的肾小球滤过率(GFR)值进行统计比较. 结果 LDN组和ODN组手术时间分别为(98.65±13.6)、(96.3±19.5)min,热缺血时间为(90.6±15.1)、(86.4±12.3)s,2组术中失血量为(105.2±34.8)、(206.35±126.4)ml(P<0.01).术后开始进食及开始下床活动时间LDN组分别为(28.55±2.9)、(25.85±3.8)h,ODN组分别为(38.6±3.3)、(36.5±5.3)h(P值均<0.01).LDN和ODN组围手术期并发症总发生率分别为6.6%(2/30)和23.3%(7/30).术后第1天、1周、3个月、6个月、1年时血肌酐水平LDN组为(109.1±7.5)、(105.4士9.5)、(96.6±10.7)、 (89.4±11.5)、(91.6±9.3)μmol/L,ODN组为(107.3±9.6)、(103.3±8.4)、(95.4±9.1)、(90.5±13.6)、(90.35±11.7)μmol/L.2组术后6个月时平均GFR值分别为64.7、65.8 ml/min,术后1年时为65.9、67.5 ml/min,与术前相比差异均有统计学意义(P<0.05),术后1年与术后6个月时相比及2组问同期比较差异均无统计学意义(P>0.05).术后1年内2组平均24 h尿蛋白定量水平及血压与术前相比及2组间同期比较差异均无统计学意义(P>0.05). 结论 LDN具有创伤小,出血少、恢复快的优点,手术安全性与ODN相当,术后1年内对供者的肾功能及血压无明显不良影响.     

Laparoscopic kidney donation: The impact of adhesions

Background Adhesion formation following abdominal surgery causes substantial burden to society. Laparoscopic donor nephrectomy (LDN) offers an opportunity to study the prevalence of adhesions in healthy individuals. Furthermore we evaluated whether or not adhesions hindered LDN. Methods Data of 161 LDNs were prospectively collected. The presence of adhesions was documented. Parameters influenced by the presence of adhesions such as operation time, blood loss, and intraoperative complications were documented. Results Twenty-eight of 44 donors (64%) who had had prior abdominal surgery presented with adhesions at laparoscopy versus 61 of 107 donors (52%) who had no history of abdominal surgery (P = 0.22). Conversion and complication rate, operation times, and blood loss did not differ between those with and without a previous history of abdominal surgery. Blood loss and operation time did not differ between donors with and without adhesions. The number of conversions to open was significantly higher in donors with adhesions (9 versus 0, P = 0.005). Three conversions were due to adhesions. Conclusion Adhesions are present in a significant number of healthy individuals regardless of a history of previous abdominal operations. As these operations are of no predictive value for the number and complexity of adhesion formation, we advocate starting live kidney donation laparoscopically as the procedure can be most probably conducted successfully by this approach. None of the above mentioned authors have any conflict of interest. Niels Kok is partially funded by an unrestricted grant of the Dutch Kidney Foundation.     

Laparoscopic Kidney Transplantation

We present the details of the first laparoscopic transplantation of a kidney from a living, related donor, performed April 16, 2009. Surgical and functional results were acceptable. Surgical time was 240 min (53 min for vascular suture), with blood loss of 300 cm³ and a hospital stay of 14 d. Serum creatinine at discharge was 73 mmol/l. Laparoscopic kidney transplantation is a complex technique that requires previous experience in vascular and laparoscopic surgery. As with all novel procedures, technical modifications will be required to formalize its use and detailed comparisons will need to be made with standard procedures.     

腹腔镜活体供肾切取术10例报告

目的　探讨活体供肾切取新方法。方法　对 10名亲属活体供肾者采用腹腔镜切取供肾 ,供者采用全身麻醉 ,经腹腔途径 ,取右侧卧位 ,在脐旁、剑突下偏右及左腹股沟韧带中点上方1.5cm各开一孔 ,脐旁放入观察镜 ,另两孔为操作孔。供肾经左下腹操作孔的延长切口用手取出。供、受者术后随访 2～ 12个月。结果　供肾切取耗时 (3.6± 0 .6 )h ,热缺血时间平均 4 .5min ;供者术后无并发症发生 ,肾功能正常 ,住院时间 (5± 1)d ,术后 2个月内均恢复正常工作。结论　腹腔镜活体供肾切取术是一种创伤小的供肾切取方法 ,供者术后疼痛轻 ,恢复快。     

68例腹腔镜活体供肾切取术的临床研究

目的:总结68例腹腔镜活体供肾切取术(laparoscopic live donor nephrectomy,LDN)的临床经验。方法:回顾分析2004年5月至2008年4月我院施行的LDN68例的临床资料,对手术时间,供肾热缺血时间,术中失血量,肾动、静脉长度进行统计,并对数据按照取左、右肾进行分组比较。根据改良的Clavien分级系统对围手术期并发症情况进行分析。术后对供者血肌酐(SCr),肾小球滤过率(GFR),24h尿蛋白定量水平,血压水平以及受者的肾功能情况进行随访。结果:68例LDN手术均取得成功,手术时间为(87.5±7.8)min,供肾热缺血时间为(85.6±13.1)s,术中失血量为(56.8±8.5)ml,肾动脉长度为(3.0±0.3)cm,肾静脉长度为(2.3±0.3)cm,按照取左右肾手术时间分别为(89.5±8.4)min和(86.8±7.2)min(P>0.05),供肾热缺血时间为(86.7±12.3)s和(85.2±14.1)s(P>0.05),术中失血量为(58.2±10.2)ml和(55.4±9.4)ml,(P>0.05),肾动脉长度为(2.5±0.3)cm和(3.5±0.3)cm(P<0.0001),肾静脉长度为(3.2±0.4)cm和(1.6±0.3)cm(P<0.0001)。围手术期3例(4.4%)出现并发症,其中Grade2b级1例,Grade1级2例。肾移植手术均获成功,受者在1周内肾功恢复正常,1例受者术后6个月并发肺部感染死亡。供者术后SCr,24h尿蛋白定量水平,GFR值维持在正常范围内,无新发高血压患者出现。结论:LDN安全、微创,完善LDN操作技术,加强对供者术后随访十分重要。     

Laparoscopic and open live donor nephrectomy: a cost/benefit study

Recently, laparoscopic live-donor nephrectomy has been developed in order to increase organ donation. In this study we compare and review the records of 10 donors operated by open extraperitoneal approach and of 10 donors operated by a laparoscopic transperitoneal approach (LSC). Results show less use of postoperative parenteral narcotics in the LSC group (109 mg vs 272 mg; P < 0.0005) than in the extraperitoneal group. Morbidity was similar in both groups. There was no difference in postoperative stay. Allograft kidney function was similar in both groups until 6 months after donation. The use of disposable laparoscopic material bears an extra cost of 900 US$. We can thus conclude that laparoscopic live-donor nephrectomy is a safe procedure that significantly reduces postoperative pain, and is not detrimental to the allograft. The total cost of the laparoscopic procedure will be lower than that of the open approach if the length of postoperative stay is cut by 3 days. Received: 17 July 1998/Revised: 12 January 1999/Accepted: 13 September 1999     

Laparoscopic nephrectomy for a nonfunctioning pelvic kidney in preparation for renal transplantation.

Pelvic kidneys pose a problem for any planned surgical intervention given their anomalous blood supply. Although minimally invasive approaches have been described for the management of benign conditions, only a handful of reports have described the use of laparoscopy for removal of ectopic or fused kidneys. We describe the laparoscopic removal of a symptomatic pelvic kidney in a patient before renal transplantation.     

经腹腔及后腹腔腹腔镜活体亲属供肾切取术(附2例报告)

目的：探讨利用腹腔镜及后腹腔镜技术行活体亲属供肾切取的手术方法,评价其安全性、可行性及临床效果。方法：术前对供、受者进行全面的免疫学检查,并对供者作详细的安全性评价,行SPECT检查了解两侧肾功能,DSA了解肾血管的变异情况。分别采用经腹腔及后腹腔的腹腔镜技术行活体亲属供肾切取,并用常规方法移植给受者。结果：2例均成功切取左肾并移植给受者,热缺血时间分别为6min及5min,血管开放后5min及10min供肾泌尿,无排斥反应及与操作技术有关的并发症,供者术后7d及5d出院,生活能自理,无并发症发生。结论：利用腹腔镜技术行活体亲属供肾切取对供者损伤小,术后康复快,对供肾功能无明显影响,技术上安全和可行。     

腹腔镜肾癌根治性切除术(附1例报告)

目的 :探讨腹腔镜肾癌根治性切除术的临床应用。方法 :为 1例 74岁的肾癌患者行手辅式腹腔镜根治性肾切除术。结果 :手术顺利完成 ,无并发症 ,术后 5d出院 ,恢复良好。结论 :腹腔镜肾癌根治性切除术具有患者创伤小 ,出血少 ,康复快 ,并发症少等优点 ,并有美观的效果     

亲属活体供肾者围手术期的处理

目的：探讨亲属活体供肾者的围手术期处理方法。方法：对５例活体供肾者的术前、术中、术后处理情况进行回顾性分析。结果：５例供肾者术后血常规和尿常规、肝肾功能、２４ｈ尿蛋白定量及血压检查均正常,平均住院１５ｄ。结论：亲属活体供肾者手术的安全系数较高,术后康复理想。     

活体亲属供肾移植12例报告

目的 探讨活体亲属供肾移植的安全性、可行性,并评价活体亲属供肾移植的临床效果。方法 对１２例活体亲属供肾移植的资料进行分析。结果 １２名供者均无并发症出现,术后７～９ｄ出院。１例受者术后移植肾功能延迟至第６周恢复正常;１例受者出现急性排斥反应,应用激素冲击治疗３ｄ后逆转;余１０例受者肾功能均恢复良好。随访满６个月的８例受者,其血尿素氮、肌酐和内生肌酐清除率分别为８．２ｍｍｏｌ／Ｌ、９７．２μｍｏｌ     

Cross-over kidney transplantation with simultaneous laparoscopic living donor nephrectomy: initial experience

With cross-over living donor kidney transplantation, immunologic incompatibilities within the original donor/recipient pair can be overcome. As minimal invasive techniques for organ recovery are increasingly applied, this should also be performed in a cross-over kidney transplantation. We present the first report of a successful simultaneous laparoscopic kidney recovery for cross-over kidney transplantation as well as a review of the international practice of cross-over kidney transplantation in the context of national laws. Cross-over kidney transplantation should be encouraged. A databank on pairs willing to participate in organ exchange programs should be created.     

Laparoscopic live donor nephrectomy for right kidneys: Experience in a German community hospital

Background Laparoscopic live donor nephrectomy has become the new gold standard for kidney procurement in many high-volume transplant centres worldwide, but it is often limited to left-sided donor kidneys. Concerns about adequate anatomical renal vessel length and sufficient surgical exposure are the main obstacles to the use of the laparoscopic approach for right kidney live donors as well. Material and methods From 1998 to 2006 we performed laparoscopic kidney procurement in 73 live kidney donors on an intention-to-treat basis, harvesting a total of 48 left (LKG) and 25 right kidneys (RKG) for transplantation. We compared these two groups with respect to operating time, conversion rate, complications, hospital stay, and recipient outcome. Results There were no differences in outcome of donor patients after left (D-LKG) or right laparoscopic donor nephrectomy (D-RKG). Operating time was 160 min in D-RKG versus 164 min in D-LKG. Warm ischemia was below 150 s in both groups. Hospital stay was 7.0 (D-RKG) versus 6.7 days (D-LKG). Negative events on the donor site were one temporary nerve irritation in each group and one postoperative retroperitoneal hematoma in the left kidney group. Reasons to convert to open nephrectomy were bleeding in two patients in the left kidney group and adhesions in one patient in the right kidney group. The outcome of the recipients after left (R-LKG) or right kidney (R-RKG) transplantation was similar. One kidney was lost due to renal vein thrombosis (R-LKG). Postoperative ureter complications occurred in one patient of each group. One patient of the R-RKG and two patients of the R-LKG required lymphocele fenestration. All other kidney transplants worked without problems. Conclusion Laparoscopic donor nephrectomy is a safe procedure and has been established as the method of choice for live kidney donation in our clinic. Laparoscopic procurement of right and left kidneys can be performed with comparable quality and outcome for donors and recipients.     

经腹膜后隙途径腹腔镜活体供肾切取32例

目的 探讨经腹膜后隙途径腹腔镜活体供肾切取的技术和效果。方法 32名供者中，男性15名，女性17名。29例取左肾，3例取右肾。供者全身麻醉，取侧卧位，共选3个穿刺点，第1个穿刺点选在12肋缘下2cm与骶棘肌外侧缘1cm交叉点，第2个穿刺点选在第1个穿刺点向前8～10cm，或肋缘下2cm与腋前线交叉点，第3个穿刺点位于髂棘上2cm与腋中线交叉点，分别插入12mm、10mm和5mm的Trocar。以自制水囊扩张器扩张腹膜后隙，游离供肾和输尿管，前6例用直线切割缝合器切断肾动脉和静脉，后26例用带锁的塑料夹夹闭切断肾动脉和静脉，在第1个穿刺点向下的延长切口将肾取出。结果 32只供肾切取顺利，手术耗时60～180min，出血量20～200ml，供肾热缺血时间3～8min，冷缺血时间25～50min。3只肾静脉较短，分别为1cm、1．5cm和2cm，另有1只供肾动脉内膜损伤。移植术后第1d，受者的尿量为2800-10 100ml，无移植肾功能恢复延迟发生。结论 经腹膜后隙途径腹腔镜活体供肾切取是安全、可行的，对供者创伤小，所获供肾的质量较好，但要求有熟练的腹腔镜技术。     

三种供肾切取方法的临床研究(附1439例报告)

目的　探讨最佳尸体供肾切取法。　方法　回顾分析 14 39例供肾切取的临床资料。比较分侧取肾、整块取肾和原位灌注整块切取三种方法的取肾手术时间 (OT)、热缺血时间 (HIT)、冷缺血时间 (CIT)、总缺血时间 (TIT)、灌洗液用量 (PS)、供肾灌注不良率 (PPK)、肾血管、肾、输尿管损伤率 (DR)以及移植后泌尿时间 (UT)、肾功能恢复正常时间 (RRT)和急性肾小管坏死发生率 (ATN)。　结果　分侧取肾法取肾 2 16例 ,获供肾 4 32只 ;整块取肾法取肾 1134例 ,获供肾 2 2 6 4只 (4例为孤立肾 ) ;原位灌注整块切取肾 89例 ,获供肾 178只。三组取肾法的HIT分别为 (8.2 2± 3.0 1)min、(5 .35± 1.88)min、(1.89± 0 .92 )min(P <0 .0 5 ) ;DR分别为 7.12 %、4 .2 6 %、2 .4 7% (P <0 .0 5 ) ;PPK分别为 15 .2 3%、10 .31%、0 (P <0 .0 5 ) ;CIT分别为 (10 .36± 7.2 9)h、(12 .5 1± 8.4 3)h、(8.6 4± 9.82 )h ,TIT分别为 (10 .4 3± 7.17)h、(12 .70± 8.6 6 )h、(9.0 3± 8.2 2 )h ,OT分别为 (6 .37± 2 .5 3)min、(7.6 5± 3.2 4 )min、(8.14± 3.94 )min ,PS分别为 (6 4 0± 75 )ml、(6 90± 93)ml、(730± 12 5 )ml(P >0 .0 5 ) ;UT分别为 (2 8.2 4± 10 .6 5 )min、(2 2 .72± 8.35 )min、(9.2 6± 10 .95 )min     

经腹膜后入路腹腔镜活体右侧供肾切取术中肾蒂的处理

目的 探讨后腹腔镜活体右侧供肾切取术的肾蒂处理方法及其安全性、临床效果.方法 2009年1月至2012年5月共实施后腹腔镜活体右侧供肾切取62例.回顾性分析供者的一般状况、术中出血量、供肾热缺血时间、手术时间、供肾血管长度、供者住院时间、并发症等.结果 62例供者手术均获得成功,无中转开放手术,无明显术后并发症.受者手术顺利,移植肾功能恢复良好.供者手术时间为(73.5±10.4)min,术中出血量为(30.7±10.4)ml,住院时间为(5.2±1.6)d.供肾热缺血时间为(107.2±24.8)s,腔静脉切口缝合时间为(2.0±0.5)min,供肾动、静脉长度分别为(3.3±0.5)cm和(2.0±0.4)cm.结论 应用后腹腔镜技术结合开放取肾通道处理肾蒂的方法切取带有腔静脉瓣的右侧肾脏,既保证了供者、供肾的安全性,又使受者手术更易顺利进行,取得了良好的临床效果.