后腹腔镜活体供肾切取术(附视频)

Retroperitoneal laparoscopic living donor nephrectomy: report of 151 cases (video)

目的总结后腹腔镜下亲属活体供肾切取术经验。方法 2003年12月至2011年12月北京大学第三医院泌尿外科共行后腹腔镜下亲属活体供肾切取术151例,手术常规取腰部3个穿刺点入路,在脂肪囊内游离肾,输尿管游离至肾下极7～8cm处夹闭远端剪断,肾动脉和肾静脉用直线切割器切断(3例)或用hem-o-lok(148例)夹闭后剪断,立即取出肾,用4℃肾保存液灌注。结果 151例手术均顺利,平均手术时间(86.0±13.6)min(54～180min),术中出血量(57.1±12.3)mL(20～200mL),所有供者均不需输血。供肾平均热缺血时间(3.6±1.2)min(2～8min)。发生术后肾区血肿3例,均自行吸收,无不良影响,其余供者均无异常。术后住院(4.8±1.7)d(3.5～9d)。受者均无移植物功能延迟发生。结论后腹腔镜下亲属活体供肾切取术安全可靠,经不断的技术改进可降低术者学习曲线,提高供肾质量。

Objective To summarize our experience on retroperitoneal laparoscopic living donor nephrectomies. Methods A total of 151 donors underwent retroperitoneal laparoscopic living donor nephrectomy in Peking University 3rd Hospital from December 2003 to December 2012. The operation was performed through 3 lumbar ports. After the kidney was fully liberated and the ureter was severed 7-8 cm under the lower pole of kidney. The renal artery and vein were blocked with Endo-cut （in 3 patients） or hem-o-lok （in 148 patients） separately and then severed; and then the kidney was quickly taken out from the donor and was immediately infused with 4 ℃ kidney preserving fluid. Results The 151 operations were successful. The average operation time was （86.0±13.6） min （54 - 180 min） and blood loss was （57.1±12.3） mL （20 -200 mL） in average. No patient required blood transfusion. The mean warm ischemia time was （3.6±1.2） min （2 - 8 min）. Three patients had hematoma of renal fossa after operation and required no further treatment. Hospital stay after operation was （4. 8±1.7） d （3.5 - 9 d）. No delayed graft function occured in all recipients who received these allogratfs. Conclusion Retroperitoneal laparoscopic living donor nephrectomy is a safe and reliable method. The modified techniques can be easier to learn and inerease the quality of the donor kidney.