摘要
目的:总结68例腹腔镜活体供肾切取术(laparoscopic live donor nephrectomy,LDN)的临床经验。方法:回顾分析2004年5月至2008年4月我院施行的LDN68例的临床资料,对手术时间,供肾热缺血时间,术中失血量,肾动、静脉长度进行统计,并对数据按照取左、右肾进行分组比较。根据改良的Clavien分级系统对围手术期并发症情况进行分析。术后对供者血肌酐(SCr),肾小球滤过率(GFR),24h尿蛋白定量水平,血压水平以及受者的肾功能情况进行随访。结果:68例LDN手术均取得成功,手术时间为(87.5±7.8)min,供肾热缺血时间为(85.6±13.1)s,术中失血量为(56.8±8.5)ml,肾动脉长度为(3.0±0.3)cm,肾静脉长度为(2.3±0.3)cm,按照取左右肾手术时间分别为(89.5±8.4)min和(86.8±7.2)min(P>0.05),供肾热缺血时间为(86.7±12.3)s和(85.2±14.1)s(P>0.05),术中失血量为(58.2±10.2)ml和(55.4±9.4)ml,(P>0.05),肾动脉长度为(2.5±0.3)cm和(3.5±0.3)cm(P<0.0001),肾静脉长度为(3.2±0.4)cm和(1.6±0.3)cm(P<0.0001)。围手术期3例(4.4%)出现并发症,其中Grade2b级1例,Grade1级2例。肾移植手术均获成功,受者在1周内肾功恢复正常,1例受者术后6个月并发肺部感染死亡。供者术后SCr,24h尿蛋白定量水平,GFR值维持在正常范围内,无新发高血压患者出现。结论:LDN安全、微创,完善LDN操作技术,加强对供者术后随访十分重要。
Objective： To summarize our clinical experiences of 68 cases with laparoseopic live donor nephreetomy （LDN）. Methods：Sixty-eight cases of LDN from May 2004 to Apr. 2008 were reviewed retrospectively. Data of operation time, donor warm ischemic time, blood loss, vessel length were collected and compared between left and right kidney groups. The procedure-related complications were analyzed according to the modified Clavien classification system. Data from recipients and donors were collected from medical and follow-up records. Serum ereatinine levels （Scr）, 24-hour urine protein excretion, glomerular filtration rate （GFR） and blood pressure of donors and Scr of recipients were followed up postoperatively. Results： All cases of LDN were successfully accomplished, mean operation time was （87. 5 ± 7. 8 ） rain, mean donor warm isehemic time was （85. 6 ± 13. 1 ） s, mean blood loss was （56. 8± 8. 5 ） ml, mean artery length was （ 3. 0 ± 0. 3 ） cm, mean vein length was （ 2. 3 ±0. 3 ） cm. For left and right LDN, mean operation time was （89. 5 ±8.4）rain and （86. 8±7. 2）rain respectively （P 〉0. 05） ,mean donor warm ischemic time was （86. 7 ± 12. 3）s and （85. 2 ±14. 1 ） s respectively （ P 〉 0. 05 ）, mean blood loss Was （ 58. 2 ± 10. 2 ） ml and （ 55.4± 9. 4 ） ml respectively （ P 〉 0. 05 ）, mean artery length was （2.5 ±0. 3）cm and （3. 5 ±0. 3）cm respectively （P 〈0. 0001 ） ,mean vein length was （3. 2 ±0. 4）cm and （ 1.6 ±0. 3）era respectively （P 〈0. 0001 ）. Perioperative complications included 1 case of Grade 2b and 2 case of Grade 1 with a total complications rate of 4. 4%. All the transplantations were successfully completed, Scr returned to normal level within 1 week after the operation in all the recipients. One recipient died of the post transplantation pneumonia 6 months after the transplantation. Levels of Scr,24-hour urine protein excretion and GFR of all donors maintained in normal condition and without new hypertension patient in donors during follow- up. Conclusions： LDN is safe and minimally invasive, it is erocial to improve the technique of LDN and intensify the follow-up work of kidney donors.
出处
《腹腔镜外科杂志》
2009年第2期91-93,共3页
Journal of Laparoscopic Surgery
关键词
腹腔镜术
肾移植
活体供者
随访
Laparosopy
Kidney transplantation
Living donors
Follow-up
作者简介
赵俊杰（1976-）男，烟台毓璜顶医院泌尿外科主治医师，主要从事微创泌尿外科及肾移植方面的研究。
