后腹腔镜活体供肾切取术115例总结

目的总结后腹腔镜下亲属活体供肾切取术115例的经验。方法我院自2003年12月至2008年11月共行后腹腔镜下亲属活体供肾切取术115例，手术常规取腰部3个穿刺点入路，在肾脂肪囊内游离肾脏后，输尿管游离至肾脏下极7．8cm处剪断，肾动脉和肾静脉用直线切割器（Endo—cut）切断或用hem—o—lok（Weck，USA）夹闭后剪断，立即取出肾脏用4℃肾脏保存液（HCA）灌注肾脏。用直线切割器处理肾血管3例，用hem—o—lok处理肾血管112例。结果115例手术均获得成功，手术时间90min（60～180min）。术中出血量60ml（20-200ml），所有供者不需输血。供肾热缺血时间4．5min（3～8min）。发生手术并发症3例，为术后肾区血肿，均自行吸收，无不良影响，其余供者均无异常。术后住院时间平均为5．7d（4～9d）。115例供者中95例得到随访，平均随访42个月（1．58个月），均健康。结论后腹腔镜下亲属活体供肾切取术安全、可靠，可替代传统开放取肾手术，但要求术者有娴熟的腹腔镜技术。

Retroperitoneal laparoscopic living donor nephrectomy: report of 115 cases

Objective To report our experience of 115 retroperitoneal laparoscopic living donor nephrectomies. Methods A total of 115 donors underwent retroperitoneal laparoscopic living donor nephrectomy from Dec 2003 to Nov 2008. The operation was performed through 3 lumbar ports. After the kidney was liberated fully and the ureter was severed 7-8 cm under the lower pole of kidney, the renal artery and vein were blocked with endo-cut or hem-o-lok separately and then severed. Endo-cut was used in 3 patients and hem-o-lok in 112 donors. Then the kidney was taken out quickly from the donor and infused with 4℃ kidney preserving fluid （HCA） immediately. Results The 115 operations were successful. The mean operative time was 90 min （60-180 min） and blood loss was 60 ml （20-200 ml）. No patient needed blood transfusion. Warm ischemia time was 4.5 min （3-8 min）. 3 patients had hematoma of renal fossa after operation and required no further treatment. Hospital stay after operation was 5.7 days（4-9 days）. 95 of 115 donors were followed up for 42 months （1-58 months）. Conolusion Retroperitoneal laparoscopic living donor nephrectomy is a safe and reliable procedure and it can replace the traditional open surgery.