手助腹腔镜肾切取术在活体供肾移植中的应用体会(附30例报告)

目的:评价手助腹腔镜活体供肾切取术的安全性及临床效果。方法:分析2013年8月至2016年8月采用手助腹腔镜活体供肾切取术获取30例活体供肾的临床资料。供者男7例,女23例,均取左肾,供受体关系为:父—子5例,母—子13例,母—女2例,兄弟2例,兄—妹4例,妻—夫3例,叔—侄1例。供肾者32~63岁,平均(51.8±8.5)岁。血型相同29例,相容1例,群体反应性抗体、淋巴毒均为阴性。30例患者均行手助腹腔镜活体供肾切取,切取后常规移植给受者,记录手术时间、出血量、供体冷热缺血时间、供者住院时间、术中副损伤及供受者术后恢复情况。结果:供者均切取左肾,手术成功,无一例中转开腹,供肾切取时间105~160 min,平均(100.4±19.5)min;失血量50~110 ml,平均(52.5±24.5)ml;供肾热缺血时间2.0~3.8 min,平均(2.4±0.5)min;冷缺血时间60~90 min,平均(68.2±26.7)min。供者术后1~3 d即可进食并下床活动,平均(2.5±0.6)d;住院3~6 d,平均(4.0±1.6)d。供受体无任何手术并发症发生,受者手术均获成功。随访3个月~3年,供体肾功能均正常。2例受者分别于肾移植术后1年8个月、1年2个月因自行减药,发生排斥反应,导致移植肾肾功能丢失,恢复透析,其余受体肾功能均正常。结论:手助腹腔镜活体供肾切取术结合了腹腔镜活体供肾切取术与开放手术的优点,既减轻了手术对供者的创伤,又保证了供肾质量,是安全、可靠的手术方法。

Hand-assisted laparoscopic living donor nephrectomy in living renal transplantation:with a report of 30 cases

Objective:To evaluate the efficiency and the safety of hand-assisted laparoscopic technique for living donor nephrectomy in renal transplantation.Methods:Clinical data of 30 living related kidney donors undergoing hand-assisted laparoscopic 1 iving donor nephrectomy during Aug.2013 to Aug.2016 were retrospectively analyzed.Of the 30 donors,7 were males and 23 were females,with age of 32 to 63 (51.8 ± 8.5) years.27 cases were living-related donors and the rest 3 were spouse.29 cases were the same blood type,and 1 case was blood compatibility.Panel reactive antibody and complement dependent cytotoxicity were negative in all cases.Operative time,blood loss,cold and warm ischemia time,the donors' postoperative hospital stay,renal or other organ injury during operation,the recovery of the donors and the function of the allografts were analyzed.Results:All cases received left side nephrectomy.The procedure was performed successfully in all 30 donors,and there was no conversion to open operation.The mean operative time was (100.4 ± 19.5) min (range,105-160 min).The estimated blood loss was (52.5 ±24.5) ml (range,50-110 ml).The warm ischemia time was (2.4 ± 0.5) min (range,2-3.8 min).The cold ischemia time was (68.2 ± 26.7) min (range,60-90 min).The mean postoperative ambulation time was (2.5 ± 0.6) d (range,1-3 d).The mean hospital stay of donors was (4.0 ± 1.6) d (range,3-6 d).No surgery related complication occurred.All renal grafts were transplanted into their recipients successfully.2 patients lost their kidney function because of reducing the dose of anti-rejection drug by themselves after 20 months or 14 months,and dialysis was performed in the 2 patients.The rest of the patients had normal renal function.Conclusions:Hand-assisted laparoscopic living donor nephrectomy has the advantage of both laparoscopic living donor nephrectomy and open donor nephrectomy.It is not only minimally invasive but also safe,and it is a reliable method for living donor nephrectomy in living renal transplantation.