机器人辅助腹腔镜肾移植术初步经验(附22例报告)

Preliminary experience of robot-assisted laparoscopic kidney transplantation(report of 22 cases)

目的:探讨机器人辅助腹腔镜肾移植手术的安全性及可行性。方法:收集2019年2月-2020年8月接受机器人辅助腹腔镜肾移植术22例患者资料,其中男13例,女9例,年龄(39.2±7.3)岁,体质量指数(22.4±3.9)kg/m2,1例有腹部手术史。术前肌酐(1045.7±256.4)μmol/L,透析时间(45.6±10.2)月,均诊断为慢性肾功能不全尿毒症期。手术方法:患者全麻插管,采用腹部6 Trocar分布,气腹压力1.729 kPa(13 mmHg),取下腹部正中切口放置自制单孔平台,剪开右侧腹膜,建立肾巢,在腹膜外游离髂外动、静脉,通过单孔平台置入移植肾,阻断并切开髂外静脉,与移植肾静脉进行端侧吻合,同样的方法吻合移植肾动脉,将移植肾置入腹膜外的肾巢内,再行移植输尿管与膀胱再植,缝合剪开的侧腹膜,将移植肾固定在肾巢内,移植肾输尿管完全腹膜外化。结果:22例手术均顺利完成,无中转开放病例,无术中输血,总手术时间(225.0±37.9)min,操作台时间(112.0±25.8)min,失血量(110.9±60.8)mL,住院天数(22.1±10.26)d,术后7、30、90 d肌酐分别为(225.5±124.1)、(116.2±49.5)、(109.2±32.2)μmol/L。术后随访2~19个月,平均8.6个月,1例肥胖患者腹部切口裂开,1例术后3个月移植肾动脉中段狭窄,2例患者术后1个月出现淋巴囊肿。结论:由既有泌尿外科机器人操作经验又有丰富的开放肾移植经验的医师进行机器人辅助腹腔镜肾移植术是安全、可行的,出血、切口感染等并发症低于开放手术,但需长期、大样本的研究。

Objective:To explore the safety and feasibility of robot-assisted laparoscopic kidney transplantation.Methods:The clinical data of 22 patients who underwent robot-assisted laparoscopic kidney transplantation in our hospital from February 2019 to August 2020 were chosen,including 13 males and 9 females,aged(39.2±7.3)years old,and body mass index was(22.4±3.9)kg/m2.One case had a history of abdominal surgery.Preoperative creatinine was(1045.7±256.4)μmol/L,and dialysis time was(45.6±10.2)months.All patients were diagnosed as chronic renal insufficiency uremic stage.For the surgical procedure,the patients were intubated under general anesthesia.The abdominal 6-trocar distribution was used.The pneumoperitoneum pressure was 1.729 kPa(13 mmHg).The central incision of the abdomen was made and a self-made single hole platform was placed.The right peritoneum was cut to establish a kidney nest,the external iliac arteries and veins were dissociated outside of the peritoneum,the transplanted kidney was placed through a single port platform,the external iliac vein was interrupted and cut,end-to-side anastomosis with the transplanted renal vein was done,the grafted renal artery was anastomosed in the same way,the transplanted kidney was placed into the peritoneum in the outer kidney nest,the transplanted ureter and bladder were replanted,and the cut lateral peritoneum was sutured,and the transplanted kidney was fixed in the kidney nest.The transplanted kidney and ureter were completely peritoneally externalized.Results:All 22 operations were successfully completed.There was no transfer to open operation.No intraoperative blood transfusion was given.The total operation time was(225.0±37.9)min,operating table time was(112.0±25.8)min,blood loss was(110.9±60.8)mL,and hospital stay was(22.1±10.26)d.The creatinine was(225.5±124.1),(116.2±49.5)and(109.2±32.2)μmol/L at 7 th,30 th and 90 th day after operation.The postoperative follow-up was 2-19 months(mean 8.6 months).One patient with obesity had a dehiscence of the abdominal incision,one patient had stenosis in the middle of the transplanted renal artery at 3 rd month after the operation,and 2 patients developed lymphatic cysts at 1 st month after the operation.Conclusion:It is safe and feasible to perform robot-assisted laparoscopic kidney transplantation by surgeons who have both urological robot operation experience and skilled experience in open kidney transplantation.The incidence of complications such as bleeding and incision infection is lower than open surgery,but it takes a long time and large sample research.