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目的探讨亲属活体供肾切取术式选择的策略及不同术式的临床效果。方法回顾总结我院2004年1月至2007年6月119例亲属供肾切取的4种术式:(1)经腹部开放手术22例;(2)经腹膜后隙腹腔镜下切肾21例;(3)经腹手助式腹腔镜下切肾13例;(4)经腰部腹膜后隙开放手术切肾63例。比较开放手术与腹腔镜手术手取肾的手术时间、供肾热缺血时间、供肾动静脉长度、供肾移植后3d内血肌酐的下降速度、供者术后平均住院日及住院费、供者术后并发症。结果开放手术比腔镜手术组:手术时间短(P=0.0033)、供肾热缺血时间短(P=0.0001);供者术后住院时间长(P=0.0000)住院费用多(P=0.0000);受者术后3d血肌酐下降速度快(P=0.0001);供肾血管长(左P=0.0000,右P=0.0001)。并发症:腔镜组:皮下气肿1例、DGF2例、术中腰静脉大出血改开放手术2例,开放组术后继发肾上腺大出血再手术1例。两组无移植肾丢失及供者生存意外发生。结论开放手术与腔镜手术切取活体供肾均是安全的术式。亲属活体供肾切取术式的选择应根据供者肾脏血管的形态、供者体形、术侧、术者对术式的熟练程度综合决定。开放手术取肾稳妥、快捷;腔镜手术取肾损伤小,恢复快,供肾血管短、移植早期血肌苷下降速度慢。
Objective To explore the strategy of choice of living donor nephrectomy and the clinical effect of different surgical procedures. Methods A total of 119 surgical procedures were performed in our hospital from January 2004 to June 2007: (1) 22 cases undergoing open abdominal operation; (2) 21 cases undergoing laparoscopic retroperitoneal laparotomy; (3) abdominal hand-assisted laparoscopic kidney resection in 13 cases; (4) open the peritoneal luteal opening surgery 63 cases of kidney. Comparison of open surgery and laparoscopic surgery, hand removal of kidney surgery time for renal ischemia, renal artery and vein length, the rate of decline of serum creatinine 3d after donor kidney transplantation, the average postoperative hospital stay and hospitalization for Postoperative complications. Results Compared with endoscopic surgery group, the open surgery time was shorter (P = 0.0033), thermal ischemia time was shorter (P = 0.0001), hospitalization time was longer (P = 0.0000) ); Recipients postoperative 3d serum creatinine decreased faster (P = 0.0001); donor vessel length (left P = 0.0000, right P = 0.0001). Complications: endoscopic group: 1 case of subcutaneous emphysema, 2 cases of DGF, intraoperative lumbar vein hemorrhage changed to open surgery in 2 cases, open group after surgery, adnexal hemorrhage again in 1 case. There was no loss of allograft in both groups and the survival of donors was unexpected. Conclusion Open surgery and endoscopic surgical removal of living donor kidneys are safe surgical procedures. Relatives living donor kidney surgery should be based on the choice of the type of renal blood vessels, donor body shape, surgery side, the surgeon’s skill of the comprehensive decision. Open surgery to take the kidney safe and efficient; endoscopic surgery to take small renal damage, rapid recovery, short supply of renal blood vessels, slow decline in the early transfer of serum creatinine.