摘要
目的探讨亲属活体供肾切取术式选择的策略及不同术式的临床效果。方法回顾总结我院2004年1月至2007年6月119例亲属供肾切取的4种术式:(1)经腹部开放手术22例;(2)经腹膜后隙腹腔镜下切肾21例;(3)经腹手助式腹腔镜下切肾13例;(4)经腰部腹膜后隙开放手术切肾63例。比较开放手术与腹腔镜手术手取肾的手术时间、供肾热缺血时间、供肾动静脉长度、供肾移植后3d内血肌酐的下降速度、供者术后平均住院日及住院费、供者术后并发症。结果开放手术比腔镜手术组:手术时间短(P=0.0033)、供肾热缺血时间短(P=0.0001);供者术后住院时间长(P=0.0000)住院费用多(P=0.0000);受者术后3d血肌酐下降速度快(P=0.0001);供肾血管长(左P=0.0000,右P=0.0001)。并发症:腔镜组:皮下气肿1例、DGF2例、术中腰静脉大出血改开放手术2例,开放组术后继发肾上腺大出血再手术1例。两组无移植肾丢失及供者生存意外发生。结论开放手术与腔镜手术切取活体供肾均是安全的术式。亲属活体供肾切取术式的选择应根据供者肾脏血管的形态、供者体形、术侧、术者对术式的熟练程度综合决定。开放手术取肾稳妥、快捷;腔镜手术取肾损伤小,恢复快,供肾血管短、移植早期血肌苷下降速度慢。
Objective To compare the clinical effects and graft outcomes of 4 surgical approaches for nephrectomy in living related kidney donors. Methods Between June, 2004 and June, 2007, 119 living related kidney donors underwent nephrectomy via different surgical approaches, and their clinical data were retrospectively analyzed. Of these donors, 22 received retroperitoneal open nephrectomy, 21 had retroperitoneoscopic nephrectomy, 13 had hand-assisted laparoscopie nephrectomy, and 63 underwent transperitoneal open nephrectomy. The operating time, warm ischemia time of the graft, renal graft artery and vein lengths, reduction rate of recipient serum creatinine in the first 3 days after renal transplantation, mean hospital stay and complications of the donors were compared between the 4 surgical approaches. Results Open surgeries were assoaeiated with significantly shorter operating time （P=0.0033） and warm isehemia time of the graft （P=0.0001）, longer hospital stay （P=0.0000）, higher hospital expenses （P=0.0000）, faster postoperative reduction of recipient serum creatinine （P=0.0001）, and longer renal artery and vein lengths （P=0.0000 on the left and P=0.0001 on the right） than laparoscopic surgeries. In the laparoscopic surgery group, subcutaneous emphysema occurred in 1 ease, DGF in 2 cases, and lumbar vein hemorrhage in 2 cases for which open surgery was performed. In the open surgery group, only one case required reoperation due to adrenal gland hemorrhage. All the kidney grafts were successfully harvested without other complications observed in the donors. Conclusions Both open and laparoscopic surgeries are safe for nephrectomy in Diving related kidney donors, and the selection of the surgical approaches depends on the kidney and donor conditions and the surgical proficiency of the surgeons.
出处
《南方医科大学学报》
CAS
CSCD
北大核心
2009年第3期500-503,共4页
Journal of Southern Medical University
基金
广东省自然科学基金(A07005177)
关键词
亲属活体供肾
器官移植
供肾切除术式
活体
living related kidney
donors
organ transplantation
living donor nephrectomy/surgical aproach
