中国首例单孔多通道经腹腹腔镜活体供肾切取术  

Transperitoneal laparoendoscopic single-site(LESS) live donor nephrectomy: the first clinical case in China

作　　者：王林辉[1] 杨庆[1] 刘冰[1] 吴震杰[1] 肖成武[1] 侯炯[2] 盛夏[1] 王利丽[2] 黄燕[2] 罗文彬[1] 陈伟[1] 王承[1] 陈楚[2] 罗睿[1] 肖亮[1] 程欣[1] 孙颖浩[1] 

机构地区：[1]第二军医大学长海医院泌尿外科,上海200433 [2]第二军医大学长海医院麻醉科,上海200433

出　　处：《第二军医大学学报》2011年第12期1329-1334,共6页Academic Journal of Second Military Medical University

基　　金：上海市市级医院新兴前沿技术联合攻关项目(SHDC12010115);军队临床高新技术重大项目(2010gxjs057);上海市重点学科项目~~

摘　　要：目的全面进行相关术前评估并取得患者知情同意后尝试进行中国首例单孔多通道经腹腹腔镜活体供肾切取术,探讨该手术的可行性和安全性,总结操作经验。方法 2011年11月9日,我科完成1例单孔多核通道(TriPortTM)经腹腹腔镜下活体供肾(左侧)切取术。供者,女,59岁,体质指数(BMI)21.6 kg/m2,术前血肌酐45μmol/L。术前核素(99mTc-DTPA)肾功能检查:左肾50 ml/min,右肾56 ml/min。受者,男,41岁,BMI 19.5 kg/m2,与供者为母子关系,术前血肌酐1 446μmol/L,因"慢性肾功能不全(肾衰竭期)"拟行肾移植术。取脐水平线上方经腹直肌纵行切口约5 cm,供肾动静脉及肾脏完全游离后,在髂血管水平离断输尿管和生殖静脉,将肾脏装入取物袋(EndoCatchTMBag),分别离断肾脏动静脉后,迅速将标本经原切口取出。结果在不增加任何额外切口的情况下顺利完成手术,手术时间210 min,术中出血50 ml,热缺血时间3.8 min。供肾动脉长度3.6 cm,静脉长度4.5 cm,输尿管长度13 cm。皮肤切口关闭时长度为5 cm。供肾移植术中再通血流后,色泽良好,20 s后即有尿液排出。供者术后第1天、第2天、第3天视觉模拟疼痛评分分别为2.5/10、1/10、0/10,术后未使用任何止痛药物,第4天出院,无任何术中或术后并发症。受者术后12 h、24 h、2 d、3 d、4 d、5 d、6 d、7 d、出院前、术后1个月血肌酐分别为:475、282、148、145、117、100、103、98、80、84μmol/L,恢复顺利,术后第10天出院。结论初步经验表明单孔多通道经腹腹腔镜下活体供肾切取术安全、可行、有效。术后供者疼痛轻,恢复快,切口小,具有良好临床应用前景,但目前完成的病例数较少,仍需进一步临床经验积累。Objective To summarize out experience in the first case of transperitoneal laparoendoscopic single-site live donor nephrectomy（LESS-DN） in China's Mainland and to assess its safety and feasibility.Methods The female donor was aged 59-year-old,with a body mass index（BMI） of 21.6 kg/m2 and a preoperative serum creatinine level of 45 μmol/L. Tc 99m-DTPA was used to determine the glomerular filtration rate（GFR）.The preoperative unilateral renal function was 50 ml/min for the left side and 56 ml/min for the right side.Recipient was a 41-year-old male,with a BMI of 19.5 kg/m2 and a preoperative serum creatinine level of 1,446 μmol/L,and who was to receive transplantation due to chronic renal dysfunction（renal failure stage）.On Nov.9th,2011,the LESS-DN was performed via a multi-channel TriPortTM（Advanced Surgical Concepts,Wicklow,Ireland） through a 5 cm skin incision at our institute.The dissection of the kidney was facilitated with the standard laparoscopic instruments at all the steps.The renal artery and the renal vein were skeletonized after the adrenal vein and the lumber vein,if any,were clipped.The ureterogonadal packet was left en bloc and transected at the level when crossing the common iliac vessels.The kidney was entrapped,and the mouth of the bag loosely cinched around the intact renal artery and vein.The renal artery and the vein were separated.The pre-entrapped kidney was extracted through the original incision after generous cranial and caudal extension of the rectus fascia incision.Results The procedure was smoothly completed without any extra skin incision.The operating time was 210 min,with an estimated blood loss of 50 ml,and a warm ischemia time of 3.8 min.The lengths of harvested renal artery,vein and ureter were 3.6 cm,4.5 cm and 13 cm,respectively. The length of skin incision at closure was 5 cm.Allograft functioned immediately on transplantation.Donor Visual Analog Pain Scores at postoperative day 1,2 and 3 were 2.5/10,1/10,and 0/10,respectively.The recovery of the donor was

关 键 词：肾移植 单孔腹腔镜手术 活体供者 肾切除术 

分 类 号：R699.2[医药卫生—泌尿科学]