经腹膜后腹腔镜活体供肾切取(附22例报告)

Retroperitoneal laparoscopic living donor nephrectomy: a report of 22 cases

目的总结经腹膜后腹腔镜活体供肾切取的治疗经验。方法对2012年1月至2014年5月在中山大学附属第一医院采用经腹膜后腹腔镜活体供肾切取术的22例供者的临床资料进行回顾性分析。手术先采用纯腹腔镜手术方式分离输尿管、肾血管及肾周脂肪,然后采用腹股沟上内侧平行切口（利用腹侧穿刺口）为取肾切口,最后在手辅助下离断肾血管并取出肾脏。记录供者手术过程、术后随访情况。结果取右侧供肾1例,左侧供肾21例。22例手术过程顺利,均无中转开放手术,手术时间（123±31）min。取肾手术切口长度为（7.2±0.5）cm。术中出血15-80 ml,热缺血时间60-150 s。供肾的肾动脉长度为2.0-3.2 cm,肾静脉长度为1.0-3.5 cm。随访1-21个月,术后1 d、1周和1个月后的血清肌酐（Scr）水平分别为（120±57）、（95±25）、（90±21）μmol/L。22例供者中,术后并发肾窝血肿、伤口愈合不良各1例。术后1周供者疼痛评分0-5分,术后1个月0-1分。无供者感觉捐肾对总体健康有明显影响,1例供者觉得对体力有一定影响。结论在严格选择供体的情况下,开展经腹膜后腹腔镜活体供肾切取具有良好的安全性。由于其切口较小,术后疼痛程度轻,对供者的生存质量影响较小。

Objective To summarize the experience of retroperitoneal laparoscopic living donor nephrectomy.Methods Clinical data of 22 donors undergoing retroperitoneal laparoscopic living donor nephrectomy in the First Affiliated Hospital of Sun Yat-sen University from January 201 2 to May 201 4 were analyzed retrospectively.The ureter,renal vessel and perirenal fat were dissected by laparoscopic approach.Then the renal vessels were cut off and the kidney was extracted by hand through superomedial inguinal parallel incision.The surgical process and the postoperative follow-up of the donors were recorded.Results One right kidney and 21 left kidneys were extracted.The operations in 22 cases were performed successfully without conversion to laparotomy.The operation time was （1 23 ±31 ）min.The length of kidney extracting incision was （7.2 ±0.5）cm.The intraoperative blood loss was 1 5-80 ml and the warm ischemia time was 60-1 50 s.The length of donor renal arteries was 2.0-3.2 cm.The length of renal veins was 1 .0-3.5 cm.The donors were followed up for 1 -21 months.The serum creatinine （Scr）levels at 1 d,1 week and 1 month after operation were （1 20 ±57）,（95 ±25）,（90 ±21 ）μmol/L respectively.Two cases suffered from renal fossa hematoma and poor wound healing after operation respectively.The pain score of the donors was 0-5 at 1 week after operation and 0-1 at 1 month after operation.No donor had the perception that donating kidney had obvious impacts on the general health,but 1 donor felt it had some influence on physical strength.Conclusions It is safe to perform retroperitoneal laparoscopic living donor nephrectomy on the basis of strict donor selection.It has little impacts on the donor＆#39;s quality of life with small surgical incision and mild postoperative pain.