后腹腔镜技术活体亲属供肾切取的可行性研究(附10例报告)

Retroperitoneoscopic live related donor nephrectomy: a report of 10 cases

目的 :探讨利用后腹腔镜技术行活体亲属供肾切取的安全性和可行性。方法 :在对供受者进行全面的免疫学检查 ,对供者作详细的安全性评价 ,行SPECT检查了解分侧肾功能 ,用DSA了解肾血管的变异情况之后 ,采用后腹腔镜技术对 10例活体亲属供肾进行切取 ,按常规方法移植给受者。结果 :10例均成功切取左肾并移植给受者 ,平均手术时间 (10 2 .6± 19.3)min ,平均术中出血量 (13.0± 9.8)ml,热缺血时间平均 (14 1.8± 72 .1)s,受体血管开放后供肾均泌尿 ,其中 1例患者移植后 1周发生输尿管远端坏死漏尿 ,再次手术后恢复正常。术后无排斥反应及其他与操作技术有关的并发症发生。结论 :利用腹腔镜技术行活体亲属供肾切取对供者损伤小 ,术后恢复快 ,对供肾功能无明显影响 。

Objective:To evaluate the safety and feasibility of retroperitoneal laparoscopic live related donor nephrectomy.Method:The recipients and the donors underwent standard thorough medical evaluation preoperatively, including immunological and imaging investigation. Retroperitoneal laparoscopic live related donor nephrectomies were performed.Result:The left kidneys of the donors were successfully harvested laparoscopically, the operation time was 102.6± 19.3 min, blood loss was 13.0± 9.8 ml, and warm ischemic time was 141.8± 72.1 sec, respectively. The allografts were implanted into the recipents and produced urine on the table immediately upon revascularization. One case of recipent occurred a leakage of urine in the distal recipient ureter a week after operation and required to repair the ureter. There were no rejection and other complications related to the techniques, serum creatinine of the recipents decreased rapidly. The donors had a short hospitalization of 5~7 days postoperatively.Conclusion:Retroperitoneal live related donor nephrectomy can lessen the burden placed on living donor and has few effects on the allograft; the operation is technically feasible and safe.