经腹腔手辅助腹腔镜活体供肾摘取术

Hand-assisted transperitoneal laparoscopic living donor nephrectomy

目的 介绍经腹腔手辅助腹腔镜活体供肾摘取术 (HLDN)。 方法 供肾者 5例 ,行经腹腔的手辅助腹腔镜活体供肾摘取术 ,总结手术方法。 结果 平均手术时间 116min ,供肾平均热缺血时间 2 .8min ,平均供肾动脉长度 1.8cm ,平均供肾静脉长度 2 .7cm。未发生任何手术并发症。术后 7d供者恢复出院 ,3例受者术后第 3～ 12天血肌酐恢复正常 ,2例受者发生肾功能延迟恢复(DGF)。 结论 HLDN结合了单纯腹腔镜供肾摘取术 (LDN)和开放供肾摘取术 (ODN)的优点 ,既有切口小、痛苦小和恢复快的微创手术特点 ,又减少了单纯腹腔镜器械操作的难度 ,使外科医师更易掌握 ,显著缩短手术时间和供肾热缺血时间 ,保证了供肾质量 ;同时有利于迅速处理一些紧急情况 ,减少并发症 。

Objective To introduce and evaluate the hand assisted transperitoneal laparoscopic technique for living donor nephrectomy. Methods Five cases treated by using the technique of the hand assisted transperitoneal laparoscopic living donor nephrectomy (HLDN) were summaried.The procedure utilized a hand assisted device for laparoscopic technique to increase safety and control of the laparoscopic technique. Results In these 5 cases,only left side nephrectomy were performed.Mean operating time was 116 min,with mean warm ischemia time being 2.8 min.Mean length of renal arteries and renal vein was 1.8 cm and 2.7 cm,respectively.There were no intra or post operative complications. Conclusions HLDN is easier than traditional laparoscopic donor nephrectomy (LDN) for the surgeons,so it can minimize the lear ning curve.HLDN can reduce warm ischemia and operating time,and also facilitate trocar placement.In addition,it can improve the prevention of torsion of the kidney,control of potential bleeding,and in the final stages of vascular stapling and kidney removal.HLDN is a promising new method for living donor nephrectomy.