腹股沟切口在后腹腔镜活体供肾切取术中的应用研究

Application of Inguinal Oblique Incision in Retroperitoneoscopic Live-donor Nephrectomy

目的研究腹股沟切口在后腹腔镜活体供肾切取术的安全性和有效性。方法选择本院2008年5月至2013年4月进行的79例后腹腔镜活体供肾切取术,根据手术标本取出切口的不同分为试验组和对照组,试验组(n=40)采用腹股沟切口取出供肾,对照组(n=36)采用腰部切口取出供肾;其余3例因肾脏粘连和肾周脂肪组织较多术中改开放手术,从对照组中剔除。两组左右侧供肾分别为35/5和32/4。对两组手术时间、术中出血量、供肾热缺血时间、供肾血管长度、患者住院时间、切口并发症、切口美容满意度进行比较。结果实验组以及对照组手术均全部成功,无死亡和重大并发症。实验组和对照组在手术时间、术中出血量差别无统计学意义。两组的供肾热缺血时间分别为(1.6±1.2)分钟对(3.3±1.6)分钟(P<0.0001);两组的左右侧供肾动脉血管长度分别为(2.6±0.4)cm对(2.2±0.3)cm(P<0.0001)和(3.7±0.3)cm对(3.1±0.4)cm(P<0.0001);两组的左右侧供肾静脉血管长度分别为(3.5±0.4)cm对(2.9±0.23)cm(P<0.0001)和(1.7±0.23)cm对(1.3±0.3)cm(P<0.0001);两组术后镇痛治疗、切口膨出、腰腹部不对称病例分别为1例和11例(P=0.001)、0例和6例(P=0.009)、1例和9例(P=0.005);住院时间分别为(5.3±2.4)天和(7.5±3.1)天(P=0.0008);差别有统计学意义。切口美容满意度(Ⅰ/Ⅱ/Ⅲ)分别为1/7/32和14/16/6(P<0.0001),实验组切口美容满意度高于对照组。结论腹股沟切口在后腹腔镜活体供肾切取术应用能够提高供肾切取的安全性,避免开放手术,保证供肾血管长度,缩短供肾热缺血时间,减少切口并发症,缩短供者住院时间,提高供者切口美容满意度,值得临床推广应用。

Objectives Evaluate the safety and effectiveness of inguinal incision application in retroperitoneal lapa -roscopic living donor nephrectomy .Methods From May 2008 to April 2013, 79 cases of retroperitoneal laparo-scopic living donor nephrectomies were selected in our hospital .All data were analysed retrospectively .All cases were grouped as test group( n=40, inguinal incision) and control group( n=36, lumbar incision) according to kidney retrieval incision .The rest of the 3 cases were converted to open operation for renal adhesion and perire-nal hyperliposis , and they were excluded from the control group .The left and right donor kidney were respective-ly 35/5 and 32/4 in two groups .Operation time , warm ischemia time , operation blood loss , kidney vessel length, hospital stay , incision complications and cosmetic satisfaction were compared .Results All 40 cases of test group and 36 cases of control group were successfully accomplished , without death and serious complica-tions.There were no differences in mean operation time and blood loss between two groups .The warm ischemia time were (1.6 ±1.2)min and (3.3 ±1.6)min, (P<0.0001).The artery length of left and right donor kid-ney were respectively (2.6 ±0.4)cm and (2.2 ±0.3)cm (P<0.0001), (3.7 ±0.33)cm and (3.1 ±0.4) cm (P<0.0001) in two groups.The vein length were respectively (3.5 ±0.4)cm and (2.9 ±0.23)cm(P<0.0001 ), (1.7 ±0.23)cm and (1.3 ±0.3)cm, (P<0.0001).Postoperative pain therapy, incision pro-lapse, waist and abdomen asymmetry were respectively 1 and 11(P =0.001), 0 and 6(P =0.001), 1 and 9 (P =0.005).Mean hospital stay were (5.3 ±2.4)d and (7.5 ±3.1)d (P =0.0008).Cosmetic satisfac-tion (Ⅰ/Ⅱ/Ⅲ) were 1/7/32 and 14/16/6 (P<0.0001), cosmetic satisfaction of test group was higher than that of control group .Conclusions Inguinal incision application in retroperitoneal laparoscopic living donor ne-phrectomy could decrease the warm ischemia time , avoid to change open surgery , guarantee the vessel length of donor kidney , increase the safety of the donor and the quality of donor kidney , offer advantage of less complica-tions and higher cosmetic satisfaction , It should be applied generally .