机器人辅助腹腔镜活体供肾切取术31例报告

目的  评估机器人辅助腹腔镜活体供肾切取术的安全性和有效性。 方法  回顾性分析2013年11月至2015年8月第四军医大学西京医院实施的31例机器人辅助腹腔镜活体供肾切取术的供、受者的临床资料。 结果  31例均顺利完成供肾切取术，手术时间110~190 min，术中出血量20~100 ml，供肾热缺血时间100~160 s，保留肾静脉长度1.8~3.0 cm，肾动脉长度1.4~2.3 cm。2例供肾取出时发生脾脏损伤，行脾脏修补术；1例供者术后出血，经止血、纠正贫血后好转。31例供者术后均随访6个月以上，均未发生远期并发症。31例受者中，1例出现移植肾功能延迟恢复，经治疗后于术后1个月血清肌酐恢复正常。移植肾存活率为100%。 结论  机器人辅助腹腔镜活体供肾切取术具有安全、可靠、创伤小、恢复快、不影响供肾功能等优势，可作为供肾切取有效而安全的手术方式。

Robot-assisted laparoscopic living donor nephrectomy: report of 31 cases

Objective To evaluate the safety and efficacy of robot-assisted laparoscopic living donor nephrectomy. Methods Clinical data of 31 donors and recipients undergoing robot-assisted laparoscopic living donor nephrectomy in Xijing Hospital of the Fourth Military Medical University from November 2013 to August 2015 were retrospectively analyzed. Results Donor nephrectomy was successfully performed in 31 cases. The operation time ranged from 110 to 190 min. Intraoperative hemorrhage volume was measured as 20-100 ml. The warm ischemia time of the donor kidney was 100 to 160 s. The retained length of renal vein was between 1.8 and 3.0 cm and the length of renal artery was 1.4 to 2.3 cm. In 2 cases, spleen injury occurred during the kidney extraction and was treated with splenorrhaphy. One donor had postoperative hemorrhage, which was treated with hemostasis and anemia correction. Thirty one donors received postoperative follow-up for over 6 months. No long-term complications were observed. Among 31 recipients, one patient had delayed recovery of renal graft function and the serum creatinine level returned to normal range after treatment at postoperative 1 month. The survival rate of kidney grafts was up to 100%. Conclusion Robot-assisted laparoscopic living donor nephrectomy is a safe and efficacious surgical procedure for kidney resection, which possesses the advantages of small trauma, rapid recovery and no influence upon renal function.