【摘要】：目的:總結(jié)后腹腔鏡下活體供腎切取術(shù)193例的經(jīng)驗,優(yōu)化改進操作技術(shù),使其更加標準化。方法:選擇北京大學(xué)第三醫(yī)院2003年12月至2016年2月行后腹腔鏡下活體供腎切取術(shù)共193例,全身麻醉下,取腰部3個通道操作,徹底游離腎后,在腎下極7~8 cm處切斷輸尿管,用endo-cut或hem-o-lok分別夾閉切斷腎動靜脈,迅速取出腎用4℃腎保存液進行灌注,然后將離體腎保存在冰鹽水中準備移植,記錄手術(shù)時間、出血量、并發(fā)癥發(fā)生情況、供者和受者腎功能情況。結(jié)果:193例手術(shù)均獲得成功,手術(shù)時間85 min(55~135 min),1例因出血手術(shù)中轉(zhuǎn)開放。術(shù)中出血量60 m L(20~200 m L),所有供者均不需輸血。供腎熱缺血時間2.2 min(2~5 min)。發(fā)生供者并發(fā)癥3例,均為術(shù)后腎區(qū)血腫,保守治療均自行吸收,未見不良影響,其余供者均未見異常。供者術(shù)后住院5.7 d(4~9 d)。193例供者中162例得到隨訪,平均隨訪42個月(1~58個月),均未見異常。2例受者發(fā)生移植腎輸尿管吻合口漏尿,經(jīng)手術(shù)修補后痊愈;3例受者發(fā)生移植腎被膜下血腫。1例受者發(fā)生移植腎功能延遲恢復(fù),其余受者腎功能恢復(fù)良好。供、受者隨訪期間腎功能均未見異常。結(jié)論:后腹腔鏡下活體供腎切取術(shù)安全可靠,經(jīng)不斷技術(shù)改良后已經(jīng)成熟和標準化,其應(yīng)用前景廣泛,但應(yīng)由有經(jīng)驗的醫(yī)生操作以預(yù)防并發(fā)癥的發(fā)生。
[Abstract]:Objective: to summarize the experience of retroperitoneal laparoscopic donor nephrectomy in 193 cases and to optimize and improve the operation technique to make it more standardized. Methods: from December 2003 to February 2016, a total of 193 patients were treated with retroperitoneal laparoscopic nephrectomy. Under general anesthesia, 3 channels of waist were removed and the ureter was cut off at the lower pole of kidney at 78 cm after completely dissociating the kidney. Endo-cut or hem-o-lok were used to cut off the renal artery and vein, and the kidney was quickly taken out and perfused with 4 鈩，

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