手助腹腔镜与开放手术活体供肾切取术的临床研究  

Hand-assisted laparoscopic versus open operation for living donor nephrectomy

作　　者：成柯[1] 刘炼[1] 王强[1] 李晨星[1] 赵于军[1] 张盛[1] 明英姿[1] 

机构地区：[1]中南大学湘雅三医院移植中心,长沙310013

出　　处：《中华移植杂志（电子版）》2014年第4期17-21,共5页Chinese Journal of Transplantation(Electronic Edition)

摘　　要：目的比较手助腹腔镜活体供肾切取术(HLDN)和开放手术活体供肾切取术(ODN)的临床疗效,观察术后受者移植肾近期存活情况。方法回顾性分析中南大学湘雅三医院移植中心2004年1月至2013年11月完成的341例亲属活体肾移植供、受者资料。根据供者手术方式的不同,将其分为HLDN组(103例)和ODN组(238例)。比较两组受者手术时长、切口长度、供肾热缺血时间、肾动脉长度、肾静脉长度、术中失血量、围手术期芬太尼用量、术后非甾体抗炎药(NSAIDs)用量和术后恢复劳动天数。术后48 h使用视觉模拟评分(VAS)法评估两组供者疼痛程度。术后随访供、受者恢复情况,并于术后7 d、1个月复查受者肾功能。连续变量采用t检验进行比较,分类变量采用Fisher确切概率法进行比较。结果 HLDN组和ODN组供者切口长度分别为(6.0±0.4)cm和(13.5±1.0)cm,术中失血量分别为(45±12)m L和(151±24)m L,差异均有统计学意义(t=73.56和42.56,P均<0.05)。两组手术时长、供肾热缺血时间、肾动脉长度、肾静脉长度相比,差异均无统计学意义(t=1.39,1.70,0.00和1.85,P均>0.05)。103例HLDN组供者中有102例顺利完成手术,1例主动中转开放,术后发生肺部感染1例,无术后切口感染及其他严重并发症。238例ODN组供者均成功完成手术,术后切口感染1例、脂肪液化2例,术后出血通过外科止血2例,无其他手术相关并发症。HLDN组和ODN组供者术后48 h VAS分别为(2.3±0.6)分和(3.9±0.9)分,围手术期芬太尼用量分别为(1.7±0.2)mg和(1.9±0.2)mg,术后NSAIDs用量分别为(22±33)mg和(47±42)mg,术后恢复劳动天数分别为(23±10)d和(44±15)d,差异均有统计学意义(t=16.52,8.48,5.37和13.00,P均<0.05)。两组供者术后7 d、1个月血清肌酐水平相比,差异均无统计学意义(t=1.76和0.00,P均>0.05)。术后HLDN组和ODN组受者各有1例发生移植物功能延迟恢复(DGF),两组发生DGF比例差异无统计学意义(0.97%Objective To evaluate the outcomes of hand-assisted laparoscopic living donor nephrectomy （HLDN） and open donor nephrectomy （ODN） , and to assess graft function of these two groups. Methods From January 2004 to December 2013, there were 341 cases living donor renal transplantation in our center. We respectively compared 103 HLDN donors to 238 ODN donors as follows ： surgery time, incision length, warm ischemia time, length of renal artery, length of renal vein,intraoperative blood loss, perioperative fentanyl dosage, postoperative non-steroidal anti-inflammatory drugs （NSAIDs） dosage and postoperative recovery work days. After 48 hours, pain was assessed by using visual analogue scale （VAS） pain assessment in two groups of donors. Recovery and renal function were followed up in the two groups of recipients at 7 days and 1 month after operation. Continuous variables were analyzed by using t test comparison, while classification variables using the Fisher＇s exact probability method. Results 102 HLDN cases were done successfully, only 1 case was required to convert to an open procedure. 238 ODN cases were also performed successfully. The HLDN group has a shorter incision length [（6.0±0.4） cm vs （13.5±1.0） cm, t=73.56, P〈0.05], lesser intraoperative blood loss [ （45 ± 12 ） mL vs （ 151 ± 24 ） mL, t = 42.56, P 〈 0.05 ] , and lower postoperative VAS score at 48 hours after operation [ （2.3 ± 0.6） vs （3.9 ± O. 9）, t = 16.52, P 〈 0.05 ）] than the ODN group. The operative time of the donors was （124 ± 40 ） minutes in the HLDN group and （112±35） minutes in the ODN group （t = 1.39, P〉0.05）. The HLDN group has a comparable warm ischemic time with the ODN group [ （2.1 ± 0.5 ） minutes vs （ 2.0 ± 0.5 ） minutes, t = 1.70, P 〉 0.05 ]. No difference in renal function was observed between the groups at 7 days or 1 month after nephrectomy. After 6 months, graft survival rate was 100% in HLDN group and 99.16% in ODN group. Conclusion HLDN is a safe a

关 键 词：手助腹腔镜 活体供肾 肾移植 

分 类 号：R699.2[医药卫生—泌尿科学]