【摘要】 目的介绍后腹腔镜下活体供肾切取术的初步经验,探讨其临床价值及可行性。方法术前对供受体进行血型、HLA配型及群体反应性抗体(PRA)检查,并对供体行IVU、彩超检查了解双肾功能、肾血管情况。采用经后腹腔途径对8例活体亲属供肾者行腹腔镜取肾术。右侧卧位,后腹腔操作通过腰部置入的3个套管完成,阻断肾血管前延长腋前线穿刺孔至6～7 cm,左手伸入后腹腔内,手助下离断肾血管并迅速取出供肾标本。结果8例手术均取得成功。手术时间96～128 min,平均112 min;术中出血25～56 ml,平均42 ml;热缺血时间126～245 s,平均152 s;肾动脉长度2．8～3．2 cm,平均3．0 cm;肾静脉长度3．2～3．5 cm,平均3．3 cm;输尿管长15～18 cm,平均16 cm。血管吻合顺利,开放血流后供肾均在1 min内开始泌尿。受体肾功能均在5 d内恢复正常,住院时间14～15 d。供体伤口引流管2～3 d内拔除,住院时间4～5 d。供受体均无外科并发症。结论后腹腔镜活体供肾切取术对患者创伤小、恢复快、供肾质量好、扩大了供肾来源。在离断肾血管及取出供肾时辅以手助可缩短热缺血时间,增加动静脉长度,提高取肾的安全性。更多还原

【Abstract】 Objective To introduce the initial experience of retroperitoneal laparoscopic live donor nephrectomy, and to evaluate its clinical significance and feasibility. Methods The donors and recipients underwent examinations of blood type, HLA matching and panel-reactive alloantibody (PRA) detection preoperatively. In addition, the donors underwent IVU and B-ultrasound to evaluate the bilateral kidney function and the condition of kidney vessels. Retroperitoneal laparoscopic live donor nephrectomy was performed in 8 cases of living donors. The donors were placed in lateral decubitus position. All laparoscopic procedures were performed retroperitoneally using 3 trocars. Before interrupting the renal blood flow, the surgeon enlarged the incision at the anterior axillary line and extended left hand into retroperitoneal cavity, then disconnected the renal artery and vein, and took out the donor graft rapidly with hand-assistance. Results The operation was successful in all 8 cases. The mean operative time was 112 min (range, 96 -128 min); mean warm ischemic time was 152 s (range, 126 -245 s) ; mean blood loss was 42 ml (range, 25 - 56 ml). The length of renal artery, vein and the ureter was 2.8 -3.2 cm ( mean, 3.0 cm), 3.2-3.5 cm (mean, 3.3 cm) , and 15 - 18 cm (mean, 16 cm) , respectively. Vascular anastomosis was performed successfully. All the grafts had uropoiesis in 1 min after reopening the blood flow. The renal function of the recipients recovered to normal in 5 d. The hospital stay of the donors and recipients were 4 -5 d and 14-15 d, respectively. Drainage tubes of the donors were removed in 2 - 3 d. No complication occurred in both donors and recipients. Conclusions Retroperitoneal laparoscopic live donor nephrectomy has advantages of minimal invasion, rapid recovery for donors, high quality kidney from donors and expansion of the source of donors. Hand-assistance can be used in the process of vessel mutilation and kidney removal, which can shorten warm ischemic time, increase the length of vessels and improve safety of the surgery.更多还原