游离肋下神经后腹腔镜活体供肾切取术的临床观察

Clinical observation of retroperitoneal laparoscopic nephrectomy of living donor kidney grafts after freeing subcostal nerve

目的研究游离肋下神经在后腹腔镜活体供肾获取术中应用的安全性和有效性。方法回顾性分析2016年1月至2019年1月在安徽医科大学第一附属医院泌尿外科行后腹腔镜活体供肾获取术的126例供者临床资料,根据获取供肾时是否游离肋下神经将其分为两组,传统手术组74例供者和游离肋下神经的改良手术组52例供者。比较两组供者切口长度、手术时间、手术中出血量、术后住院时间、热缺血时间和术后12 h、24 h和48 h视觉模拟评分法(visual analogue scale,VAS)。结果126例取肾手术都获得成功,无1例中转开放。传统组和改良手术组在切口长度、手术时间、热缺血时间、手术中出血量之间差异均无统计学意义(P均>0.05),传统手术组术后住院时间为(6.6±1.7)d,改良手术组术后住院时间为(4.8±1.7)d,两组间差异具有统计学意义(P<0.001)。改良手术组术后12 h、24 h、48 h的VAS评分均显著低于传统手术组,差异具有统计学意义(P<0.001)。结论与传统切口后腹腔镜手术比较,采用游离肋下神经的腹膜后腔镜供肾获取术是安全可行的,可完整保留肋下神经,缩短住院时间及术后近期疼痛。

Objective To study the safety and efficacy of retroperitoneal laparoscopic living donor nephrectomy after freeing subcostal nerve.Methods The clinical data of 126 donors who underwent retroperitoneoscopic living donor nephrectomy in the department of urology,the First Affiliated Hospital of Anhui Medical University from January 2016 to January 2019 were retrospectively analyzed.The donors were divided into two groups depending on whether the subcostal nerve was freed during donor kidney harvesting,there were 74 donors in the traditional surgery group and 52 donors in the modified surgery group with freeing subcostal nerve.The donor’length of incision,surgery time,intraoperative blood loss,the length of hospitalization,kidney warm ischemia time and visual analogue scale(VAS)at 12 h,24 h and 48 h after surgery were compared between the two groups.Results All patients(n=126)finished the nephrectomy successfully,and none was transferred to open surgery.The differences in the length of incision,surgery time,kidney warm ischemia time and intraoperative blood loss between the two groups had no statistical significance(P>0.05).The postoperative hospital stay was(6.6±1.7)d in the traditional surgery group and(4.8±1.7)d in the modified surgery group,and the difference between the two groups had statistical significance(P<0.001).The VAS scores at 12 h,24 h and 48 h after operation in the modified operation group were significantly lower than those in the traditional surgery group,and the differences were statistically significant(P<0.001).Conclusion Compared with traditional retroperitoneoscopic surgery,retroperitoneal laparoscopic donor nephrectomy with freeing subcostal nerves is safe and feasible,it can completely preserve the subcostal nerves and shorten the length of hospital stay and short-term postoperative pain.