腹股沟斜切口在后腹腔镜活体供肾切取术中的临床应用分析

研究腹股沟斜切口在后腹腔镜活体供肾切取术中应用的安全性和有效性。方法回顾性分析2008年5月至2012年3月在烟台毓璜顶医院泌尿外科行后腹腔镜活体供肾切取术的76例供者临床资料，根据供肾取出切口的不同将其分为两组，腹股沟切口组40例供者和腰部切口组36例供者分别采用腹股沟斜切口和腰部切口取出供肾。比较两组供者手术时间、术中出血量、供肾血管长度、住院时间、术后切口并发症发生情况和切口美容满意度。结果腹股沟切口组40例供者手术均成功；腰部切口组33例供者手术成功，3例因肾粘连和肾周脂肪组织较多改开放手术；两组均未发生死亡和严重并发症。两组手术时间和术中出血量差异均无统计学意义（P均＞0.01）。腹股沟切口组供肾热缺血时间为（1．6±1．2）min，短于腰部切口组，差异有统计学意义（t＝5．18，P＜0．01）。腹股沟切口组左、右侧供肾动脉血管长度分别为（2．6±0.4）cm和（3．7±0．3） cm，均长于腰部切口组；腹股沟切口组左、右侧供肾静脉血管长度分别为（3．50±0．40）cm和（1．70±0．23）cm，均长于腰部切口组，差异均有统计学意义（t＝4．75，7．32，76．3，6．45，P均＜0.01）。腹股沟切口组术后需接受镇痛治疗和腰腹部外观不对称的供者比例均低于腰部切口组，切口美容满意度高于腰部切口组，差异有统计学意义（χ2＝12．52，7．41，32.53，P均＜0．01）；腹股沟切口组无供者发生切口膨出，腰部切口组有6例供者发生切口膨出，两组比较差异有统计学意义（P＝0．009）。腹股沟切口组住院时间明显短于腰部切口组（t＝3.42，P＜0．01）。结论采用腹股沟斜切口的后腹腔镜活体供肾切取术能够提高手术安全性，保证最佳供肾血管长度，明显缩短供肾热缺血时间，减少切口并发症，提高供者切口美容满意度，值得临床推广。

Clinical analysis of inguinal incision in retroperitoneal laparoscopic living donor nephrectomy

Objective To evaluate the safety and effectiveness of inguinal incision in retroperitoneal laparoscopic living donor nephrectomy .Methods The clinical data of76 donors who underwent retroperitoneal laparoscopic living donor nephrectomies in Yantai Yuhuangding Hospital from May 2008 to March 2012 were retrospectively analyzed .They were divided into the observation group who adopted inguinal incision to exteriorize kidney （ n=40） , and the control group who adopted lumbar incision to exteriorize kidney （ n =36 ）. Operation time, blood loss, renal vascular length, hospitalization time, incision complications and cosmetic satisfaction were compared between 2 groups. Results All 40 cases of the observation group and 33 cases of the control group operations were successful , 3 cases of the control group were converted to open operation due to kidney adhesion or peripheral adipose tissue , without death and serious complications .There were no differences in mean operation time and blood loss between 2 groups.The ischemic time were （1.6 ±1.2） min and （3.3 ± 1.6） min in the observation group and the control group （t=5.18, P〈0.01） respectively.The artery length of left and right donor kidney were （2.6 ±0.4） cm vs （2.2 ±0.3） cm （t=4.75, P〈0.01） and （3.7 ±0.3） cm vs （3.1 ±0.4） cm （t=7.32, P〈0.01） in the observation group and the control group, respectively.The vein length of left and right donor kidney were （3.50 ±0.40） cm vs （2.90 ± 0.23） cm （t=7.63, P〈0.001） and （1.70 ±0.23） cm vs （1.30 ±0.30） cm （t=6.45, P〈0.01） in the observation group and the control group , respectively .The proportion of undergoing analgesic treatment and the incidence of waist and abdomen asymmetry were 2.5%（1/40） vs 33.3%（11/33） and 2.5% （1/40） vs 27.3% （9/33） in the observation group and the control group , respectively, with statistically significant differences （χ2 =12.52, 7.41, all P〈0.01）. The incidence of incision bulging were 0 vs18 .2% （6/33） in the observation group and the control group （P =0.009）, respectively.Mean hospitalization time of the observation group and the control group were （5.3 ±2.4） d and （7.5 ±3.1） d （t=3.42, P〈0.01）.Cosmetic satisfaction of the observation group was 80%（32/40）, higher than that of the control group （15.2%, 5/33）, with a statistically significant difference （χ2 =32.53, P〈0.01）.Conclusions The inguinal incision in retroperitoneal laparoscopic living donor nephrectomy can improve the safety of operation , ensure the vascular length of donor kidney , shorten graft warm ischemia time , decrease incision complications and improve cosmetic satisfaction, and be worthy to be applied in clinic .