【摘要】 目的比较机器人辅助腹腔镜活体供肾切取术与后腹腔镜活体供肾切取术的临床疗效,评估机器人辅助腹腔镜供肾切取术对供、受者的安全性和有效性。方法回顾性分析2013年9月至2015年8月第四军医大学西京医院泌尿外科31例行机器人辅助腹腔镜活体供肾切取术(机器人组)及29例行后腹腔镜活体供肾切取术(后腹腔镜组)供、受者临床资料。比较机器人组和后腹腔镜组供者术前一般情况、手术时间、热缺血时间、术中出血量、住院时间、并发症发生情况、术后随访情况,以及两组受者手术前后血清肌酐值、手术并发症和术后移植肾功能。计量资料组间比较采用t检验,计数资料组间比较采用χ2检验。结果机器人组与后腹腔镜组手术均顺利完成。两组供者术中出血量分别为(39±15)和(62±37)m L,住院时间分别为(4.6±1.0)和(5.4±1.5)d,差异均有统计学意义(t=3.01和2.46,P均<0.05);手术时间、热缺血时间及并发症发生率差异均无统计学意义(P均>0.05)。此外,机器人辅助腹腔镜组2例供者术中出现脾脏损伤,1例出现术后出血;后腹腔镜组1例供者术后出现泌尿系统感染,1例术后术后第6天发现髂外静脉血栓,1例术后出现伤口脂肪液化。两组供者术后随访6个月以上,均无高血压、蛋白尿、肾功能异常等并发症发生。两组受者术后第7、30天血清肌酐值分别为(120±26)和(132±43)μmol/L,(115±18)和(118±39)μmol/L,差异均无统计学意义(t=0.78和0.96,P均>0.05)。机器人组及后腹腔镜组受者移植肾存活比例分别为100.0%(31/31)和96.6%(28/29)。结论机器人辅助腹腔镜活体供肾切取术具有安全、可靠、创伤小、恢复快、不影响供移植肾功能等优势,是一种可供选择的供肾切取方式。更多还原

【Abstract】 Objective To compare the outcomes of robot-assisted laparoscopy and retroperitoneal laparoscopy for living donor nephrectomy and to investigate the safety and feasibility of robot-assisted laparoscopic living donor nephrectomy. Methods Sixty cases of living donor nephrectomy from September 2013 to August 2015 were retrospectively reviewed. Thirty-one donors were performed with robot-assisted laparoscopic living donor nephrectomy( robot group),Twenty-nine donors underwent retroperitoneal laparoscopic living donor nephrectomy( retroperitoneal group).General preoperative, operation time, warm ischemia time, intraoperative hemorrhage volume,hospitalization time, complications and data of follow-up of the donors, and preoperative and postoperative serum creatinine value,complications and allograft function of the recipients between the two groups were compared. Results Both of the two groups were performed successfully.Intraoperative hemorrhage volume and hospitalization time of robot group and retroperitoneal group were( 39 ± 15) and( 62 ± 37) m L,( 4. 6 ± 1. 0) and( 5. 4 ± 1. 5) d,respectively,both were significantly reduced in robot group( t = 3. 01 and 2. 46,P all < 0. 05). But operation time,warm ischemia timeand complications occurred rate in the two groups had no significant difference( P all > 0. 05). In robot group,2 donors occured with splenic injury during operation and 1 donor was detected with hemorrhage after operation. In retroperitoneal group,1 donor occured with urinary tract infection,1 donor occured with external iliac vein thrombosis,1 donor was detected with wound fat liquefaction after operation. All the donors were followed up for more than 6 months,no hypertension,proteinuria,renal dysfunction and other long-term complications were detected. The blood creatinine of robot group and retroperitoneal group of recipients after operation of 7th day and 30 th day were( 120 ± 26) and( 132 ± 43) umol / L,( 115 ± 18) and( 118 ± 39) umol/L,respectively,there was no statistical difference( t = 0. 78 and0. 96,P all > 0. 05). The survival rate of recipients in the two groups were 100%( 31 /31) and96. 6%( 28 /29),respectively. Conclusions Robot-assisted laparoscopic nephrectomy was a safe,reliable,minimal invasive and effective procedure for living-donor kindey transplantation,which was an alternative way for living donor nephrectomy.更多还原