经腹膜后入路腹腔镜活体供肾切取技术的改良及效果观察  

Improvement and effect of retroperitoneal laparoscopic living donor nephrectomy

作　　者：田野[1] 张磊[1] 解泽林[1] 林俊[1] 郭宇文[1] 孙雯[1] 朱一辰[1] 郭宏波[1] 唐雅望[1] 

机构地区：[1]首都医科大学附属北京友谊医院泌尿外科,北京市卫生局泌尿外科研究所,100050

出　　处：《中华器官移植杂志》2012年第10期580-583,共4页Chinese Journal of Organ Transplantation

基　　金：国家重点基础研究发展计划（2009CB522401）

摘　　要：目的对经腹膜后入路腹腔镜活体供肾切取技术进行改良，并观察其临床效果。方法回顾分析2009年7月至2012年6月间41例采用改良的经腹膜后入路腹腔镜技术切取供。肾的临床资料。改进的方法包括：（1）肾脏游离采用钝性分离加剪刀锐性分离，超声刀间断止血的联合方法进行；（2）肾动、静脉及输尿管充分游离完毕后，在侧腹部自Trocar套管孔向下做平行腹直肌切口约5～6cm长，沿肌纤维走行方向分别钝性分离牵开腹外斜肌、腹内斜肌和腹横肌，进入腹膜后腔。术者左手经此切口进入腹膜后腔，重新建立气腹；（3）直视下经Trocar套管置入活检枪，在术者固定供肾情况下穿刺获得“零点”活检样本；（4）术者左手适度牵拉肾动、静脉，依次在肾动、静脉近心端用2枚Hem-o-lock夹夹闭，剪刀离断肾动、静脉后直接取出供肾。结果41例供肾切取术均获成功，无中转开放手术。手术耗时65～130min，平均85min，供肾热缺血时间58～110s，平均78S，供肾动脉长2．1～3．7cm，平均2．9cm，供肾静脉长2．5～4．1cm，平均3．5cm。术中出血量15-80ml，平均28ml。供者术后住院时间4～7d，平均4．8d。41例均获得“零点”活检供肾穿刺样本。除2例发生轻微淋巴漏外，未发生其他手术并发症。41例受者移植肾功能恢复顺利，未出现移植肾功能恢复延迟。结论改良的经腹膜后入路腹腔镜供肾切取技术安全、有效，能进一步保护移植肾功能和减少供者的损伤程度。Objective To improve the technology of retroperitoneal laparoscopic living donor nephrectomy and observe its clinical effect. Methods Forty-one cases of living donors subject to nephrectomy by the new retroperitoneal laparoscopic technique from July 2009 to June 2012 were retrospectively. The new technique was modified as follows.. （1） Alternate use of blunt dissection, sharp dissection and harmonic scalpel; （2） After separation of renal vein, artery and ureter, a 5-6 cm incision parallel to rectus abdominis from Trocar was made in order to put a hand inside retroperitoneum; （3） A biopsy of the kidney was made from Trocar with the help of a hand for holding the kidney; （4） Pulling the kidney with a proper strength and blocking renal artery and renal vein with Hem-o-lock, then cutting off them and taking out the kidney. Results Forty-one cases of live donors subject to nephrectomy were operated on successfully, and were not converted to open operation. The operative time was 65-130 min （mean 85 rain）. The warm ischemia time was 58-110 s （average 78 s）. Living donor kidney artery length was 2. 1-3. 7 cm （average 2. 9 cm）. Living donor kidney vein length was 2. 5-4. 1 cm （average 3. 5 cm）. Blood loss was 15-80 ml （average 28 ml）. Hospital stay after surgery was 4-7 days （average 4. 8 days）. All biopsy specimens were achieved from 41 cases. None suffered from complications except two cases of perilymphorrhea. Forty-one recipients recovered well after renal transplantation. Conclusion The improved retroperitoneal laparoscopic living donor nephrectomy is considered to be safe, effective and feasible. It is a good way to protect renal functionand reduce injury.

关 键 词：肾移植 活体供者 腹腔镜 腹膜后腔 

分 类 号：R699.2[医药卫生—泌尿科学]