经腹膜腔途径腹腔镜活体供肾切取术的临床应用  

Laparoscopic living donor nephrectomy with transperitoneal approach

作　　者：熊玮[1] 邓小凡[1] 杨洪吉[1] 冉清[1] 窦科[1] 狄文佳[1] 张宇[1] 

机构地区：[1]四川省医学科学院四川省人民医院器官移植中心,四川成都610072

出　　处：《西部医学》2010年第2期256-258,共3页Medical Journal of West China

摘　　要：目的总结经腹膜腔途径腹腔镜下活体供肾切取技术及临床效果。方法回顾性分析经腹膜腔途径腹腔镜活体供肾切取。供受关系为：父-子1例，母-子／女8例，同胞兄弟姐妹9例，夫妻间供肾1例。群体反应性抗体及淋巴细胞毒试验均阴性，供肾植于右髂窝。结果19例均为左肾，均成功取肾，无中转开放，手术时间180～270min，热缺血时间120-300s，术中估计出血量约100-350ml。供者术后平均住院天数7．3d，无并发症发生。受者随访3～16个月，发生缓慢肾功能恢复1例，急性排斥2例，经激素冲击后好转。结论经腹膜腔腹腔镜活体供肾切取具有安全、对供体创伤小、恢复快等优点，要求术者有熟练的腹腔镜手术血管处置技术。Objective To summarize the technique and effect of laparoscopie living donor nephrectomy via transperitoneal approach. Methods 19 donors were underwent laparoscopic donor nephrectomy. All procedures were left via transperitoneal approach. Under general anesthesia, all donors were placed in a lateral decubitus position, Four transperitoneal trocars were used through different ports. The first 10 mm camera port was placed 1cm left lateral to umbicus and then the pneumoperitoneum was established. The surgeon made the donor kidney ureter and renal vessels dissociated. Finally, the dissected donor kidney and ureter were taken out through an incision extended from the two trocar ports. Re- suits All the 19 grafts were dissected successfully. The duration of procedure was ranged from 180 to 270 min, and the volume of blood loss was from 100 to 350 ml. The range of warm isehemia time was 2 to 5 rain, and 60 to 150 rain of cold ischemia time. Short renal vessel was found in 1 case with 1. 5 era renal artery. On the day after transplantation, the u- rine volume of recipient s was from 3700 to 16000ml. There was one slow graft function found in recipients. All living donors had no severe surgical complications with normal renal function when discharged from the hospital. Conclusion Laparoscopic living donor nephrectorny via transperitoneal approach is available and safe with minimal invasion and less pain to donors. The skillful laparoscopic technique help to obtain donor grafts with higher safety and quality.

关 键 词：肾移植 腹腔镜 活体供者 肾切除 

分 类 号：R699.2[医药卫生—泌尿科学]