两种开放手术入路在活体供肾切取术中的应用  

Comparison between two operation approaches in live donor nephrectomy

作　　者：孙建明[1] 陈善群[1] 许足三[1] 李勇[1] 孙龙飞[1] 曾向阳[1] 

机构地区：[1]郴州市第一人民医院泌尿二区,湖南郴州423000

出　　处：《海南医学》2011年第4期36-38,共3页Hainan Medical Journal

摘　　要：目的探讨活体供肾切取术的切口选择,并比较前肋缘下切口经腹及经腹膜外两种手术入路的优缺点。方法将68例活体亲属肾移植供肾切取术分为两组:斜卧位肋缘下切口腹膜外途径取肾术42例为观察组,平卧位肋缘下切口经腹途径26例为对照组。观察两组间手术时间、出血量、肛门排气时间、术中术后并发症、住院天数、供肾热缺血时间、肾动脉长度。结果观察组、对照组手术时间分别为(180±20)min、(188±25)min,两组差异无统计学意义(P>0.05);出血量分别为(80±20)ml、(80±40)ml,两组比较差异无统计学意义(P>0.05);肛门排气时间分别为(1.5±0.5)d、(2.2±0.8)d,两组比较差异有统计学意义(P<0.05);观察组1例术后肺不张,对照组2例脾损伤、1例结肠损伤、1例不完全性肠梗阻,并发症比较差异有统计学意义(P<0.05);两组住院天数分别为(10.5±3.1)d、(13.6±3.5)d,两组间比较差异有统计学意义(P<0.05);供肾热缺血时间分别为(2.5±1.3)min、(2.2±1.4)min,两组比较差异无统计学意义(P>0.05);动脉长度分别为(25.1±5.2)mm、(24.5±6.3)mm,两组比较差异无统计学意义(P>0.05)。结论斜卧位肋缘下切口腹膜外途径取肾术略优于平卧位肋缘下切口经腹途径取肾术,供肾者恢复快、并发症少。Objective To discuss the choice of approaches in live donor nephrectomy,and compare the clinical effects of two approaches which on the edge of epigastrct through extraperitoneal or intraperitoneal passage in living related kidney donors.Methods From June 2003 to November 2009,68 living related kidney donors underwent nephrectomy had been divided into two groups basing on the different surgical approaches.42 cases who received nephrectomy through retroperitoneal were enrolled into observation group,and 26 cases who underwent trans-peritoneal nephrectomy were enrolled into control group.These clinical data had been compared between the two groups such as the operating time,quantity of bleeding,anal exhaust time,complication of intra-operation and postoperation,mean hospitalization days,warm ischemia time and artery lengths of graft kidney of the donors.Results The operating times were 180±20 and 188±25 min in observe group and control group,the quantity of bleeding were 80±20 and 80±40 ml in observe group and control group,the warm ischemia time of the grafted renal were 2.5±1.3 and 2.2±1.4 min in observe group and control group,the artery lengths of grafted kidney were 25.1±5.2 and 24.5±6.3 mm in observe group and control group,there were no significantly difference between the two group.But,the anal exhaust time were 1.5±0.5 and 2.2±0.8 days in observe group and control group,the mean hospitalization days were 10.5±3.1 and 13.6±3.5 days in observe group and control group,these had statistical significance（P 0.05）,There are 1 case with pulmonary atelectasis after operation in observe group,but 2 cases with injury of spleen,1 case with injury of colon and 1 case with incomplete intestinal obstruction in control group,and there were significantly difference between the two group on complication（P 0.05）.Conclusion The retroperitoneal surgical approach is better than that of trans-peritoneal in nephrectomy.The donors come back rapidly and have less complications.

关 键 词：肾移植 活体 取肾术 手术入路 

分 类 号：R699.2[医药卫生—泌尿科学]