程序优化下后腹腔镜左侧活体供肾切取术238例总结

doi:10.19558/j.cnki.10-1020/r.2020.01.002

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摘要 目的：探讨程序优化下后腹腔镜下左侧活体供肾切取术(LLDN)238例的临床经验及安全性。方法：选择2011年11月–2019年3月在中国人民解放军总医院第八医学中心移植外科由单一术者行后腹腔镜下左侧亲属供肾切取术的238例供者资料。手术常规取腰部3个穿刺点,采用程序化供肾切取的游离顺序：①充分利用肾周无血管解剖层面,首先游离肾脏腹侧面,快速显露肾静脉腹侧,然后从逆时针方向游离肾下极、输尿管、肾动脉和肾静脉背侧、肾上极,最后与肾静脉腹侧面汇合。在肾脏游离过程中完成血管属支的处理和输尿管的显露;②保留输尿管周围脂肪,尽可能保护输尿管的血供,游离输尿管至跨髂血管处剪断;③充分游离供肾及动静脉后,将腹侧Trocar切口延长5 cm,术者左手握住肾脏,牵引供肾血管,用Hem-o-lok分别夹闭肾动脉和肾静脉后剪断,迅速取出供肾交台下灌注及修整。结果：238例供肾切取手术均成功,无中转开腹及供肾废弃,供者100%安全。左肾动脉多支30例,其中2支25例,3支5例（3例全部术中吻合,2例第3支细小分支CTA未显影,术中偶然发现结扎废弃）。腔镜操作手术时间37~186 min,平均（73±22）min。热缺血时间1.1~4.5 min,平均（2.3±0.8）min。出血10~350 mL,平均（45±20）mL,均未输血。发生手术并发症6例,淋巴瘘1例,短期自愈,腰静脉损伤出血2例,被膜下血肿3例,均无严重并发症。术后住院时间5~10 d,平均（6.3土1.2）d。238例供者随访1~15个月,平均7个月,均健康。结论：程序优化下后腹腔镜下亲属供肾切取术安全可靠,可以降低学习曲线,提高供肾质量。

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	解俊杰
	石炳毅
	李钢
	范宇
	刘炎忠
	罗用文
	杨锦涛
	李超
	齐宝玉
	柏宏伟

关键词 ：腹腔镜, 程序性优化, 活体供肾, 供肾切取术, 肾移植

Abstract：Objective： To discuss the experience and safety of program optimization of retroperitoneal laparoscopic left living donor nephrectomies for 238 consecutive cases. Methods： A total of 238 donors undergoing retroperitoneal laparoscopic left living donor nephrectomy from Nov. 2011 to March 2019 were selected. The operation was performed through 3 lumbar ports. The sequence of donor dissociation was routinized: (1) Make full use of the anatomic level of perirenal vasculature, first dissociate the ventral side of the kidney, quickly expose the ventral side of the renal vein, then dissociate the lower pole, ureter, renal artery and dorsal side of the renal vein, upper pole of the renal vein in the counterclockwise direction, and finally make peace with the ventral side of the renal vein. During the process of kidney dissociation, the treatment of vascular branch and ureter exposure were completed. (2) Retain the fat around the ureter, protect the blood supply of the ureter as far as possible, and free the ureter to cut it across the iliac vessels. (3) After the donor kidney and arteries and veins were fully freed, the ventral Trocar incision was extended for 5 cm. The operator held the kidney with his left hand, pulled the donor kidney vessels, and then Hem-o-lok was used to clip the renal arteries and veins respectively and cut them off. The donor kidney was quickly removed for perfusion and dressing under the stage. Results： The 238 operations were successful, and all donors were safe. There were 30 patients with multiple branches of the left renal artery, including 25 with two branches and 5 with three branches (3 cases were given intraoperative anastomosis, 2 cases had no CTA development of the third branch, and ligation was found to be abandoned by accident during the operation). The operative time was 37-186 min [mean (73±22) min]. The mean time of warm ischemia was 1.1-4.5 min [mean (2.3±0.8) min]. The bleeding was 10-350 mL [mean (45±20) mL]. No blood transfusion was performed. There were 6 cases of surgical complications, including 1 case of lymphatic fistula, obtaining short-term self-healing, 2 cases of lumbar vein injury bleeding, and 3 cases of subcapsular hematoma. There were no serious complications. Postoperative hospital time was 5 to 10 days, with an average of 6.3 days. 238 donors were followed up for 1 to 15 months, with an average of 7 months. Conclusion： It is safe and reliable to perform retroperitoneal laparoscopic living donor nephrectomy, which can reduce the learning curve and improve the quality of donor kidney.

Key words： laparoscope procedural optimization living donor kidney donor nephrectomy kidney transplant

收稿日期: 2019-05-27

ZTFLH:

R617

基金资助:北京市科技计划课题（首都特色临床应用项目 Z17110000107184）

通讯作者: 柏宏伟,baihongwei99@163.com

引用本文:

解俊杰, 石炳毅, 李钢, 范宇, 刘炎忠, 罗用文, 杨锦涛, 李超, 齐宝玉, 柏宏伟. 程序优化下后腹腔镜左侧活体供肾切取术238例总结[J]. 微创泌尿外科杂志, 2020, 9(1): 6-11.
JIE Junjie, SHI Bingyi, LI Gang, FAN Yu, LIU Yanzhong, LUO Yongwen, YANG Jintao, LI Chao, QI Baoyu, BAI Hongwei. Program optimization of retroperitoneal laparoscopic left living donor nephrectomy: experience in 238 consecutive cases. JOURNAL OF MINIMALLY INVASIVE UROLOGY, 2020, 9(1): 6-11.

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http://journal20.magtechjournal.com/Jwk_zgmnwk/CN/abstract/abstract1558.shtml 或 http://journal20.magtechjournal.com/Jwk_zgmnwk/CN/Y2020/V9/I1/6

[1] MJOEN G, OYEN O, HOLDAAS H, et al.Morbidity and mortality in 1022 consecutive living donor nephrectomies: benefits of a living donor registry. Transplantation, 2009,88(11):1273-1239.
[2] MITRE AI, DÉNES FT, NAHAS WC, et al. Comparative and prospective analysis of three different approaches for live-donor nephrectomy. Clinics (Sao Paulo), 2009,64(1):23-28.
[3] 中华医学会器官移植学分会,中国医师协会器官移植医师分会.中国活体供肾移植临床指南(2016 版).器官移植,2016,7(6):417-426.
[4] LI G, DONG J, LU JS, et al.Anatomical variation of the posterior lumbar tributaries of the left renal vein in retroperitoneoscopic left living donor nephrectomy. Int J Urol, 2011,18(7):503-509.
[5] IBRAHIM HN, FOLEY R, TAN LP, et al.Long-Term Consequences of kidney donation. N Engl J Med, 2009,360(5):459-469.
[6] 石炳毅. 应重视亲属活体供肾移植的医疗安全性.中华泌尿外科杂志,2006,27(10):653-655.
[7] MINNEE RC, IDU MM.Laparoscopic donor nephrectomy. Neth J Med, 2010,68(5):199-206.
[8] 柏宏伟,钱叶勇,石炳毅,等.后腹腔镜下左侧活体供肾切取术35例报告.中华泌尿外科杂志,2014,35(1):24-27.
[10] 董隽,卢锦山,祖强,等.改良手辅助后腹腔镜活体供肾切取术.中华移植杂志(电子版),2010,4(3):219-220.
[11] GIACOMONI A, DI SANDRO S, LAUTERIO A, et al.Robotic nephrectomy for living donation: surgical technique and literature systematic review. Am J Surg, 2016,211(6):1135-1142.
[12] 魏强,徐健,刘小友,等.腹腔镜活体供肾切取手术操作培训课程体系的构建.腹腔镜外科杂志,2009,14(10):762-764.
[13] MINNEE RC, BEMELMAN WA, MAARTENSE S, et al.Left or right kidney in hand-assisted donor nephrectomy. A randomized controlled trial. Transplantation, 2008,85(2):203-208.
[14] LIU XS, NARINS HW, MALEY WR, et al.Robotic-assistance does not enhance standard laparoscopic technique for Right-Sided donor nephrectomy. JSLS, 2012,16(2):202-207.
[15] SU LM, RATNER LE, MONTGOMERY RA, et al.Laparoscopic live donor nephrectomy trends in donor and recipient morbidity following 381 consecutive cases. Ann Surg, 2004,240(2):358-363.
[16] REESE PP, FELDMAN HI, ASCH DA, et al.Short-term outcomes for obese live kidney donors and their recipients. Transplantation, 2009,88(5):662-671.