【摘要】 目的介绍改良手助后腹腔镜下活体供肾切取术的临床经验,探讨其临床价值及安全性。方法对85例活体亲属供肾者行改良手助后腹腔镜下活体供肾切取术,后腹腔操作通过腰部置入的3个套管完成,供肾及其输尿管和动静脉的游离均在传统腹腔镜下完成,阻断肾血流前向下延长腋前线穿刺孔至6～7cm,术者左手或右手置入后腹腔内,手助下离断肾血管并迅速取出供肾标本。观察记录手术中出血量、手术时间、供肾热缺血时间、手术切口及供肾动静脉长度、手术并发症的发生情况及供受体术后血肌酐的恢复情况。结果 85例手术均取得成功,无中转开腹的病例发生。手术时间90～135min,平均115min;供肾热缺血时间112～247s,平均155s;术中出血量30～85mL,平均51mL;手助切口的长度6.0～7.2cm,平均6.5cm;肾动脉长2.7～3.3cm,平均2.9cm;肾静脉长度2.6～3.8cm,平均3.4cm,住院时间4～5d,平均4.5d。术中术后无大出血、气胸或肺栓塞等严重并发症发生,仅4例供体术后出现皮下气肿,未作特殊处理自行吸收,供受体术后的血肌酐均在1周内降至正常。结论改良手助后腹腔镜活体供肾切取术兼有腹腔镜手术创伤小、恢复快和手助方式下热缺血时间短、安全性高的优点,且无需特殊的手助系统,节约了手术成本。更多还原

【Abstract】 [Objective] To introduce the clinical experience of modified hand-assisted retroperitoneoscopic live donor nephrectomy (HARLDN) and to evaluate its clinical significance and safety.[Methods] 85 living related renal donors underwent modified hand-assisted retroperitoneoscopic live donor nephrectomy and procedures were performed retroperitoneally through the three trocars located in the waist.The mobilization of the kidney and its vessels and ureter was performed under pure laparoscopic surgery.Before interrupting the renal blood flow,the surgeon prolonged the incision at the anterior axillary line downward to 6～7cm in length and extended his left or right hand into retroperitoneal cavity.Then the surgeon transected the renal artery and vein and extracted the donor graft rapidly with hand assistance.The parameters were collected,which included operating time,estimated blood loss,warm ischemia time,the renal vessels and incision length,operating complications,hospital stays and the serum creatinine 7 days and 1 month in postoperative donors and recipients.[Results] HARLDN was effectively and safely completed in 85 (100%) donors.No conversion to open operation occurred.The mean operation time and mean warm ischemic time was 115 minutes (range 90～135) and 155 seconds (range112～247),respectively.The mean blood loss was 55mL (range 30～85).Mean hospital stay was 4.5days (range 4～5).The mean hand-assisted incision length was 6.5cm (range 6.0～7.2).No major intraoperative and postoperative complication such as massive haemorrhage,pneumothorax and pulmonary embolism occurred in the donors.Only 4 donors suffered from pneumoderma absorbed without any special treatment.The level of postoperative serum creatinine of both the donors and the recipients recovered to normal.[Conclusions] Modified hand-assisted retroperitoneoscopic live donor nephrectomy presents advantages of not only minimal invasion and rapid recovery for donors in laparoscopic surgery but also minimal warm ischemia time and high safety owing to hand assistance.Furthermore,it saves the operative costs without use of any special hand-assisted device.更多还原