机器人辅助腹腔镜下亲属供肾切取术12例报告

Surgical outcomes of robot-assisted nephrectomy for living-donor kidney transplantation in 12 cases

目的总结机器人辅助腹腔镜下亲属活体供肾切取术的经验，探讨该术式对供者及受者的安全性和有效性。方法2013年9月至2014年1月对12例亲属活体。肾移植供者行机器人辅助腹腔镜下供肾切取术，男2例，女10例。年龄38—60岁，平均47岁。均为父母给子女供肾。11例为左侧左肾，1例右侧供肾。12例受者均为慢性肾小球肾炎致尿毒症患者，男8例，女4例。年龄20～36岁，平均26岁。血液透析时间8～25个月，平均14个月。记录手术时间、术中出血量、术中肾脏热缺血时间、术中保留。肾动静脉长度、手术并发症、供受者肾功能变化等。结果12例均无中转开放手术。手术时间（气腹时间）110～195min，平均140min；术中出血30～120ml，平均50ml；供肾热缺血时间100—280s，平均170S。术中保留肾静脉长度1．9～3．0cm，平均2．4cm；动脉长度1．4～2．3cm，平均1．8cm。2例供肾取出时发生脾脏损伤，行脾修补术，未切除脾脏。所有供者术后5d出院。受者术后随访均未出现移植肾功能延迟恢复。结论机器人辅助腹腔镜下亲属供肾切取术具有安全、可靠、创伤小、恢复快、不影响供。肾功能等优势。供肾取出时应注意保护脾脏。

Objective To summarize the surgical experience about the robot-assisted laparoscopic nephrectomy for living-donor kidney transplantation, as well as its efficacy and safety. Methods From September 2013 to January 2014, the clinical data of 2 male and 10 female patients who were underwent robot-assisted nephreetomy for living-donor kidney transplantation in our hospital were analyzed. The mean age in those patients were 47 years old （range 38 to 60 years old）. 11 underwent a left nephrectomy and the 12th patient underwent a right nephrectomy. As to the receptor, all of them, including 8 male and 4 female patients, were suffered from the uremia due to the chronic glomerulonephritis. The mean age in those receptors were 26 years old （range 20 to 36 years old） .The duration of hemodialysis in those patients ranged from 8 to 25 months （mean 14 months）. Their transplanted kidneys were all donated from their parents. Operative time,bleeding volume,warm ischemia time , length of vein and artery preservation, surgical related compli- cation and changing of renal function in donor were analyzed. Results All patients underwent totally ro- botic nephrectomy without open procedure conversion. The median console time was 140 minutes （range 110-195 min）. Median intraoperative bleeding was 50 ml （range 30-120 ml）. The median warm ischemia time was 170 s （range 100-280s）. The median length of vein preservation was 2.4 cm （range 1.9-3.0 cm） and 1.8 cm （range 1.4-2.3 cm） for artery. Spleen injuries occurred in two cases when the kidney was taken out and splenorrhaphy was performed. The hospital stay of all donors was 5 days. None of the transplant recipients developed delayed graft functional recovery. Conclusions Robot-assisted laparoscopic nephrectomy is a safe, reliable, minimal invasive and effective procedure for living-donor kidney transplantation. More attention, however, should be paid to the spleen when the left kidney is taken out.