后腹腔镜供肾切取术的解剖程序化操作

Anatomical and programmed in retroperitoneal laparoscopic living donor nephrectomy

目的研究后腹腔镜活体供肾切取术的最佳手术方式及其系统化操作。方法回顾性分析了本院2011年3月至2015年4月进行的45例经后腹腔镜活体供肾切取术治疗的患者的临床资料及手术操作,手术概括如下:(1)取侧卧位,选择穿刺点腋后线肋缘下2 cm(A)腋前线肋缘下2 cm(B)髂脊上2 cm(C);(2)游离肾脏和输尿管;(3)游离肾动静脉并切断肾上腺静脉、生殖静脉及输尿管;(4)做腹股沟切口,切断肾动静脉。结果 45例后腹腔镜活体取肾手术均成功,无中转开放手术,平均手术时间(62±7)min,平均供肾热缺血时间(1.2±0.6)min;平均供肾动脉长度:左肾(2.5±0.4)cm,右肾:(3.5±0.6)cm;平均供肾静脉长度:左肾(3.6±0.4)cm,右肾:(1.7±0.2)cm;平均术中出血量(45±4)ml,供者平均术后住院时间(4.5±1.5)d,对术后切口美容满意度均较好。结论后腹腔镜活体供肾切取术安全有效,解剖程序化操作是降低手术难度,减少手术并发症,提高手术安全性和缩短学习曲线的有效途径。

Objective To investigate the best surgical method and systematic operation of retroperitoneal laparoscopic living donor nephrectomy. Methods Forty-five cases of living donors subject to nephrectomy by the new retroperitoneal laparoscopic technique from March 2011 to April 2015 were retrospectively analyzed. Procedure were as follows： （1）lateral position and select the puncture point A posterior axillary line and 2cm below costal arch （A）, anterior posterior axillary line and 2cm below costal arch （B）, 2 cm above iliac crest （C）; （2）dissociate kidney and ureter; （3）dissociate the vessel of renal and cut off the vein of adrenal and reproductive, then cut off the ureter; （4）make an incision from groin, cut off the arteriovenous vessel of renal. Results All operations were completed successfully, no one converted to open surgery. The mean operating time was （62±7） min, the mean warm ischemia time was （1.2±0.6） min. Living donor kidney artery length： （2.5±0.4） cm in left, （3.5±0.6） cm in right. Living donor kidney vein length： （3.6±0.4） cm in left, （1.7±0.2） cm in right. Blood loss was （45±4） ml. Hospital stay after operation was （4.5±1.5） d, the incision beauty satisfaction was good.Conclusions It is safe and effective of the new retroperitoneal laparoscopic living donor nephrectomy. Programmed operation of the anatomy is the best way to reduce the operation difficulty and complications, can increase the safety obviously and shorten the learning curve.