无气腹悬吊腹腔镜活体供者取肾术与开放手术的比较

Comparative study of gasless suspend laparoscopy live donor nephrectomy and open live donor nephrectomy

目的:评价无气腹悬吊腹腔镜活体供者取肾手术(SGLLDN)的临床价值。方法:比较40例SGLLDN和32例开放活体供者取肾手术(OLDN)的临床效果。结果:SGLLDN组39例成功,转开放手术1例;OLDN组32例全部成功。SGLLDN与OLDN相比,切口长度较短,(8.0±2.3)cm vs(19.5±3.5)cm(P<0.01);手术时间较长,(120.1±16.2)min vs(60.5±12.1)min(P<0.05);术中出血量较少,(158.5±45.3)mL vs(289.2±65.1)mL(P<0.01);住院时间较短,分别(5.0±1.0)d vs(9.0±2.0)d(P<0.05);术中供肾热缺血时间和术后肾功能恢复正常时间二者差异无统计学意义(P>0.05)。结论:与OLDN相比,SGLDN具有切口创伤小、出血少、患者恢复快、住院时间短等优点。缺点是手术时间稍长、费用稍贵。临床可根据不同供者要求选择不同手术方法。

Objective： To evaluate clinical application of suspend laparoscopy donornephrectomy（SGLLDN） . Methods： Retrospective analysis of 40 cases of SGLLDN and 32 cases of open live donor nephrectomy（OLDN） and investigate the safety and efficiency of SGLLDN. Results： SGLLDN were succeed to developed in 39 cases. However,there was 1 case failed and transfered to open operation（2.5%） . The incision length was（8.0±2.3） cm in SGLLDN vs（19.5±3.5） cm in OLDN（P0.01） . The operation time was（120.1±16.2）） min in SGLLDN group vs（60.5±12.1） min inOLDN group,respectively（P0.05） . The blood loss during operation was（158.5±45.3） mL vs（289.2±65.1） mL（t=-12.96,P0.01） ,and postoperative hospitalization was（5.0±1.0） days vs（9.0±2.0） days,respectively（t=-12.96,P0.01） . There was significant difference between SGLLDN and OLDN in postoperative WBC count and CRP leve（lP0.01） . The WBC count was（12.5±2.3） × 109 vs（17.2±1.6） ×109 respectively. While CRP level was（23.5±6.7 vs 44.6±8.2） . There were no complications in both group,respectively. The warm ischemia time was（110.5±32.3） s in SGLLDN vs（119.6±23.5） s in OLDN group（P0.05） ,and there were no statistics difference in warm ischemia time for the dnoer during the operation and time for postoperative renal function returning to normal between the two groups.Hospitalization time was significant different between SGLLDN and OLDN group（P0.05） . Conclusion： Compared with OLDN,SGLLDN has advantages of minimal morbidity,small incision,less bleeding and rapid recovery. This method could be considered as the first option in the live donor of kidney.