以输尿管为导向的后腹腔镜活体供肾切取术的临床研究

李金锋; 张浩杰; 丰贵文; 孙佳佳; 尚文俊; 庞新路; 谢红昌; 丰永花; 王志刚; 杨先雷

doi:10.13201/j.issn.1001-1420.2018.11.008

以输尿管为导向的后腹腔镜活体供肾切取术的临床研究

- 郑州大学第一附属医院肾移植科(郑州, 450052)
基金项目:
河南省教育厅高等学校重点科研项目 (编号18A320041)

详细信息

通讯作者: 李金锋,E-mail:jinfenglis512@126.com

中图分类号: R699

收稿日期: 2017-12-23

Clinical analysis of ureter-guided retroperitoneal laparoscopic biopsy for kidney resection

- Department of Kidney Transplantation, First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China

More Information

Corresponding author: LI Jinfeng, E-mail: jinfenglis512@126.com

Received Date: 23 December 2017

摘要

摘要: 目的:对后腹腔镜活体供肾切取采取以输尿管为导向的手术方法,并观察其临床效果。方法:回顾性分析2015年6月~2017年8月我院89例亲属肾移植供者的临床资料,供者男31例,女58例;年龄25~67岁,平均(50.8±10.1)岁,均取左肾。其中35例采取常规后腹腔镜供肾切取术(对照组),54例采取以输尿管为导向的后腹腔镜供肾切取术(研究组)。比较两组手术时间、热缺血时间(WIT)、BMI、出血量、术后早期视觉模拟评分法(VAS)评分、术后肾功能监测指标、围手术期并发症、下床时间、住院时间、排气时间等指标。结果:对照组和研究组手术时间分别为(83.9±12.5) min和(71.8±13.9) min,下床时间分别为(30.6±7.5) h和(26.9±7.8) h,组间比较差异均有统计学意义(P<0.05);对照组和研究组并发症发生分别为5例和1例,组间比较差异有统计学意义(P<0.05);但两组BMI、WIT、出血量、术后早期VAS评分、术后肾功能监测指标、住院时间、排气时间比较,差异均无统计学意义(P>0.05)。对照组发生1例肾动脉损伤,1例腹膜后血肿,1例轻微淋巴漏,2例切口脂肪液化;研究组发生1例切口脂肪液化。所有移植手术均获成功,对照组1例发生移植肾功能延迟恢复,术后4周肾功能恢复正常,余88例肾功能2周内恢复正常。结论:以输尿管为导向的改良后腹腔镜活体供肾切取有助于快速、准确地找到肾蒂各个解剖结构,从而缩短手术时间,减少并发症,降低学习曲线,可在临床上推广。
- 肾移植 /
- 活体供者 /
- 后腹腔镜
Abstract: Objective: To observe the clinical effect of the ureter-oriented operation method on retroperitoneal laparoscopic donor nephrectomy.Method: The clinical data of 89 cases of living-related kidney transplantation donors from June 2015 to August 2017 were analyzed retrospectively.There were 31 males and 58 females aged 25-67 years old with the average of (50.8±10.1).The left kidney were removed.The first 35 cases were treated with conventional retroperitoneal laparoscopic donor nephrectomy (control group), while others underwent ureter-oriented laparoscopic nephrectomy (study group).The operative time, warm ischemia time, blood loss, early postoperative VAS pain score, postoperative renal function monitoring index, perioperative complications, hospitalization time and exhaust time were compared between the two groups.Result: The operation time of the control group and the study group were (83.9±12.5) min and (71.8±13.9) min respectively.The mean postoperative on bed time of the control group and the study group were (30.6±7.5) h and (26.9±7.8) h, and the number of complication cases were 5 cases and 1 case respectively.There was significant difference between the two groups (P<0.05).However, there was no significant difference between the two groups in the time of warm ischemia, the amount of bleeding, BMI, the early postoperative VAS pain score, the postoperative renal function monitoring index, the hospitalization time or the exhaust time.One case of renal artery injury, 1 case of retroperitoneal hematoma, 1 case of mild lymphatic leakage, and 2 cases of fat liquefaction of incision ccurred in the control group.In the study group, 1 case of fat liquefaction occurred.All the kidney transplantations were successful.One case of delayed graft function occurred in the control group, and 4 weeks later renal function returned to normal, The rest 88 cases of renal function resumed to normal within 2 weeks.Conclusion: Ureter-oriented retroperitoneal laparoscopic donor nephrectomy can help to find the anatomical structure of the renal pedicle quickly and accurately, thereby reducing the operation time and operation complications.In summary, the learning curve can be reduced, so we can apply the method clinically.
- renal transplantation /
- living donor /
- retroperitoneal laparoscopy

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