半月线取肾切口在经腹膜后腹腔镜活体供肾切取术中的应用经验  

Spigelius＇ line incision as a successful route to extract the kidney during retroperitoneal laparoscopic live-donor nephrectomy

作　　者：邱江[1] 陈国栋[1] 吴子玄 王道虎[1] 邓素雄[1] 王长希[1] 陈立中[1] Qiu Jiang;Chen Guodong;Wu Zixuan;Wang Daohu;Deng Suxiong;Wang Changxi;Chen Lizhong(Organ Transplant Unit 2,The First Affiliated Hospital,Sun Yat-sen University,Guagnzhou 510080,China)

机构地区：[1]中山大学附属第一医院器官移植二区,广州510080

出　　处：《中华泌尿外科杂志》2018年第11期856-858,共3页Chinese Journal of Urology

摘　　要：目的探讨经腹膜后腹腔镜活体供。肾切取术采用半月线切口取出供肾的优点、定位方法和手术步骤。方法回顾性分析2012年9月至2017年7月行经腹膜后腹腔镜活体供肾切取术的114例供者的临床资料。114例中，采用半月线切口取肾（半月线组）39例，男13例，女26例；平均年龄35岁；左肾35例，右肾4例。采用Gibson切口取肾（Gibson组）75例，男28例，女47例；平均年龄3l岁；左肾73例，右肾2例。手术均采用全麻。先采用纯腹腔镜手术方式分离输尿管、肾血管及肾周脂肪，最后在手辅助下离断肾血管并取出。肾脏。半月线组采用经半月线切口，经腹直肌旁在腹直肌鞘边缘（半月线）打开前鞘，在弓状线和腹壁下血管之间将侧腹膜推向中线即可暴露腹膜后空间；Gibson组采用经腹股沟内上方平行切口取出供肾。比较两组的切口长度、术中出血量、热缺血时间及手术时间。结果l14例手术均未中转开放手术。半月线组和Gibson组的手术切口长度分别为（6．8±0．6）cm和（7．0±0．4）cln，术中出血量分别为（59．2±33．4）ml和（80．7±32．8）ml，差异均有统计学意义（P=0．02，P=0．002）。半月线组和Gibson组的热缺血时间分别为（2．8±1．1）min和（3．1±1．7）min，手术时间分别为（160．8±30．7）min和（162．5±28．1）min，差异均无统计学意义（P=0．31，P=0．77）。两组术后均未发生切口疝。结论与Gibson切口比较，采用半月线切口行经腹膜后腹腔镜供肾切取术是安全可行的，可完全避开腹壁肌群，避免损伤腹壁主要神经及腹腔脏器。Objective To introduce the advantages, incision designing methods and surgical procedures of spigelius＇ line incision in retroperitoneal laparoscopic living donor nephrectomy. Methods Among the 114 donors,39 were obtained by spigeliu＇ line incision （13 males and 26 females）, with an average age of 35 years ,35 left kidneys and 4 right kidneys. Gibson incision was performed in 75 patients （28 males and 47 females） , with an average age of 31 years,73 left kidneys and 2 right kidneys. The clinical data of 114 donors undergoing retroperitoneal laparoscopic living donor nephrectomy from September 2012 to July 2017 were analyzed retrospectively. The operation was performed by laparoscopie surgery to separate the ureter,renal vessels and perirenal fat. Finally,the renal vessels were removed and the kidneys were removed with hand-assistant. 75 cases were taken out of the kidney through the inguinal parallel incision （ Gibson incision） ,while the other 39 cases used the spigelius＇ line incision （Through the linea pararectalis, the anterior sheath is cut opened at the margin of the rectus sheath （spigelius＇ line） and the lateral peritoneum is pushed into the midline between the arcuate line and the inferior abdominal vessels to expose the retroperitoneal space ）. The intraoperative data were collected. Results All the operations were not converted to open surgery. The incision length of the spigelius＇ line incision group was （6.8± 0.6） cm, and the incision length of the Gibson incision group was （ 7.0±0. 4 ） cm, P = 0. 02. The blood loss of the operation of the spigelius＇ line incision group was （ 59.2 ±33.4 ） ml, while the Gibson incision group was （80.7 ±32.8） ml, P = 0. 002. The warm ischemia time of the spigelius＇ line incision group was （2.8 ± 1.1 ） min, while the Gibson incision group was （3. 1 ± 1.7 ） min, P = 0. 31. The operation time of the spigelius＇ line incision group was （160.8± 30.7）min, while the Gibson incision group was（ 162.5 ＋ 28

关 键 词：肾移植 活体 腹腔镜 供肾切取术 切口 

分 类 号：R699.2[医药卫生—泌尿科学]