后腹腔镜联合Gibson切口多囊肾切除一期同种异体肾移植术3例报道并文献复习

Simultaneous retroperitoneoscopic nephrectomy and kidney transplantation using Gibson incision in patients with autosomal dominantpolycystic kidney disease:report of three cases and literature review

目的探讨多囊肾尿毒症患者采用后腹腔镜联合Gibson切口进行多囊肾切除一期同种异体肾移植的可行性及安全性。方法回顾性分析2015年10月至2016年10月期间收治的3例多囊肾尿毒症患者的临床资料并进行随访。3例患者均采用斜侧卧位后腹腔镜方式切除右侧多囊肾,经Gibson切口取出多囊肾一期行同种异体肾移植手术。统计手术时间、术中出血量、术后胃肠道功能恢复时间及围手术期并发症等指标,术后定期随访,观察移植肾功能及患者存活情况。结果手术均成功完成,1例肾切除手术中转手助腹腔镜,无中转开放手术。手术时间平均3.67 h,术中出血量平均133 ml。术后胃肠道功能恢复时间平均2.7 d。术后伤口疼痛VAS评分平均3.3分,无其它肾切除或肾移植并发症。术后平均随访半年,3例患者均存活,术后1周、1月、3月及半年血肌酐水平分别为143.3μmol/L、128.3μmol/L、90.7μmol/L及80.7μmol/L。结论后腹腔镜联合Gibson切口多囊肾切除一期同种异体肾移植术具有可行性,同时具有创伤小、疼痛轻、恢复快的优势,其安全性尚需进一步验证。

Objective To evaluate the feasibility and safety of simultaneous retroperitoneoscopic nephrectomy and kidney transplants, using Gibson incision in patients with autosomal dominant polycystic kidney disease. Methods Retrospective analyzed three cases of patients with autosomal dominant polycystic kidney disease from Oct - 2015 to Oct - 2016. All of them underwent simultaneous retroperitoneoscopic nephrectomy and kidney transplantation using Gibson incision. Operative time, intraoperative blood loss, recovery time of gastrointestinal function and perioper-ative complications were recorded. Allograft function and survival of recipients were followed up. Results All cases of nephrectomy were comple-ted without conversions to open surgery. Mean operative time was 3. 67 h. Mean amount of blood loss was 133 ml. Mean recovery time of gastroin-testinal function was 2. 7 d. Mean VAS score was 3.3. Other complications did not occurred. After a half - year follow - up, all three patients sur-vived with a functional allograft. Serum creatinine post - operatively at one week, one month, three month and half a year was 143. 3 μmol/L, 128.3 μmol/L, 90.7 μmol/L and 80.7 [xmol/L, respectively. Conclusion Simultaneous retroperitoneoscopic nephrectomy and kidney trans-plantation using Gibson incision in patients with autosomal dominant polycystic kidney disease is feasible, with an advantage of small trauma, little pain, and quick recovery. Further studies are required to determine the safety of surgery.