机器人辅助活体肾移植的早期经验  

Early experience of robot assisted living donor kidney transplantation

作　　者：张浩涵 宋涂润[1] 马铭 吴佳沛 范钰[1] 王显丁[1] 黄中力[1] 林涛[1] Zhang Haohan;Song Turun;Ma Ming;Wu Jiapei;Fan Yu;Wang Xianding;Huang Zhongli;Lin Tao(Organ transplantation center,Institute of Urology,West China Hospital,Sichuan University,Chengdu 610044,China)

机构地区：[1]四川大学华西医院泌尿外科,泌尿外科研究所,器官移植中心,成都610044

出　　处：《中华器官移植杂志》2022年第6期334-339,共6页Chinese Journal of Organ Transplantation

基　　金：国家自然科学基金(81870513、81470980、81600584);四川大学青年基金(2017SCU11042);四川省卫生和计划生育委员会科研课题(17PJ159、18PJ434、18PJ453)。

摘　　要：目的研究机器人辅助活体肾移植的安全性及早期预后, 绘制掌握该术式的学习曲线。方法本研究纳入四川大学华西医院自2020年7月至2021年3月完成的30例机器人辅助活体肾移植病例资料。随访时间为3个月。采用累积总和法绘制学习曲线。根据学习曲线将30例受者分为练习期(前17例)与熟练期(后13例)两组, 比较其手术各阶段时间及早期预后。术后比较两组受者肾功能, 围手术期并发症, 评估机器人辅助活体肾移植技术的安全性及有效性。结果 30例机器人辅助活体肾移植均顺利完成, 手术时间(221.4±36.1)min。围手术期未发生肠梗阻、移植肾功能延迟、漏尿及切口感染。平均肛门排气时间为(1.9±0.2)d。在随访中, 2例受者出现肺部感染, 1例出现急性排斥反应, 经治疗后均好转。由学习曲线发现静脉吻合、动脉吻合、热缺血时间、输尿管吻合分别需要10例、12例、12例、17例手术操作以达到熟练水平;整个手术过程平均需要15例操作以达到熟练水平。根据所有手术操作的熟练程度, 以17例为分界将受者分为练习期及熟练期, 发现两组受者手术时间[(235.5±31.6)min比(203±34.3)min, P=0.012]及热缺血时间[(63.7±24.9)min比(47.0±11.3)min, P=0.033]差异有统计学意义, 术后在部分时间点熟练组肌酐低于练习组, 如术后第7天[(192.7±135.2)μmol/L比(107.8±27.9)μmol/L, P=0.022], 术后30 d[(147.8±46.3)μmol/L比(112.3±28.0)μmol/L, P=0.021], 但估算肾小球滤过率(eGFR)差异无统计学意义, 术后第7天[(56.1±34.1)ml/(min·1.73m^(2))比(72.0±18.5)ml/(min·1.73m^(2)), P=0.14], 术后第30天[(56.2±18.9)ml/(min·1.73m^(2))比(68.7±15.3)ml/(min·1.73m^(2)), P=0.14]。结论机器人辅助活体肾移植是安全可行的, 学习曲线大约需要17例达到熟练程度。Objective To explore the safety and early prognosis of robot assisted living donor kidney transplantation(KT)and plot the learning curve of mastering the operation.Methods From July 2020 to March 2021,30 cases of living robot assisted KT were completed.The follow-up period was 3 months.Cumulative sum analysis was performed for plotting the learning curve.According to the learning curve,they were divided into two groups of practice period(the first 17 cases)and proficiency period(the last 13 cases).Time of each operative stage and early prognosis were compared.Kidney function and perioperative complications of two groups were compared for evaluating the safety and effectiveness of robot assisted KT.Results The average operative duration was(221.4±36.1)min.No intestinal obstruction,delayed graft function,urinary leakage and incision infection occurred during perioperative period.The average anal exhaust time was(1.9±0.2)days.During follow-ups,both pulmonary infection(2 cases)and acute rejection(1 case)improved after treatment.According to the learning curve,venous anastomosis(10 cases),arterial anastomosis(12 cases),warm ischemic time(12 cases)and ureteral anastomosis(17 cases)should be performed for reaching a proficiency level.An average of 15 operations was required for achieving proficiency throughout operations.Significant inter-group differences existed in operative duration[(235.5±31.6)vs(203.0±34.3)min,P=0.012]and warm ischemic time[(63.7±24.9)vs(47.0±11.3)min,P=0.033].At some postoperative timepoints,creatinine of proficiency group was lower than that of practice group,such as Day 7 post-operation[(192.7±135.2)vs(107.8±27.9)μmol/L,P=0.022]and Day 30 post-operation[(147.8±46.3)vs(112.3±28.0)μmol/L,P=0.021].However,no significant difference existed in estimated glomerular filtration rate at Day 7 post-operation[(56.1±34.1)ml/(min·1.73m2)vs(72.0±18.5)ml/(min·1.73m^(2)),P=0.14]and Day 30 post-operation[(56.2±18.9)ml/(min·1.73m^(2))vs(68.7±15.3)ml/(min·1.73m^(2)),P=0.14].Conclusions Robot as

关 键 词：肾移植 机器人辅助技术 学习曲线 

分 类 号：R699.2[医药卫生—泌尿科学]