后腹腔鏡活體供腎切取術(shù)的臨床應(yīng)用
發(fā)布時(shí)間：2019-03-04 09:00
【摘要】：背景： 全球范圍內(nèi),尿毒癥的發(fā)病率不斷上升。據(jù)統(tǒng)計(jì),每一百萬(wàn)人口中每年約有100-150人發(fā)生尿毒癥。我國(guó)現(xiàn)有需要血液透析或腎移植的終末期尿毒癥患者約130萬(wàn),并且以每年20-30萬(wàn)人的速度在增加。腎移植術(shù)是治療尿毒癥的主要方法之一,相對(duì)于血液透析及腹膜透析而言,能更好的提高患者的生存質(zhì)量并能延長(zhǎng)存活的時(shí)間,由于目前尸體供腎的嚴(yán)重缺乏,國(guó)內(nèi)腦死亡尚未立法,心臟死亡器官捐獻(xiàn)(DCD)剛剛起步,遠(yuǎn)遠(yuǎn)不能滿足臨床需要。正如此,親屬活體供腎腎移植在國(guó)內(nèi)許多移植中心所占的移植比例不斷升高。隨著醫(yī)療技術(shù)的進(jìn)步,后腹腔鏡活體取腎(RPLDN)已成為活體取腎的主要方法,能效控制術(shù)中出血,保護(hù)腎臟功能,臨床效果良好。本文通過(guò)與傳統(tǒng)開放活體供腎切取術(shù)(ODN)和手助式后腹腔鏡下供腎切取術(shù)(HLDN)的臨床效果比較,評(píng)價(jià)后腹腔鏡下供腎切取術(shù)(RPLDN)的臨床價(jià)值。 目的： 通過(guò)與傳統(tǒng)開放活體供腎切取術(shù)(ODN)和手助式后腹腔鏡下供腎切取術(shù)(HLDN)的臨床效果比較,評(píng)價(jià)后腹腔鏡下供腎切取術(shù)(RPLDN)的臨床價(jià)值。 方法： 選取山東省千佛山醫(yī)院2003年7月至2013年7月間的共207例親屬活體腎移植供受者為研究對(duì)象,其中ODN82例,HLDN20例,RPLDN105例,手術(shù)均獲得成功。通過(guò)對(duì)研究對(duì)象圍手術(shù)期并發(fā)癥、手術(shù)時(shí)間、估計(jì)出血量、中轉(zhuǎn)開腹手術(shù)率、熱缺血時(shí)間、平均住院時(shí)間、腎移植受者術(shù)后并發(fā)癥發(fā)生率等指標(biāo)進(jìn)行回顧性分析。通過(guò)病案調(diào)閱、門診隨訪、電話隨訪等方式獲取相關(guān)臨床資料,通過(guò)對(duì)比研究,評(píng)價(jià)腹腔鏡活體取腎手術(shù)的安全性和有效性。 結(jié)果： 三組均成功完成手術(shù),無(wú)中轉(zhuǎn)開放手術(shù)者。RPLDN組平均手術(shù)時(shí)間較HLDN、ODN組短(P0.05)；術(shù)中失血量腔鏡手術(shù)組明顯少于ODN組,術(shù)后住院時(shí)間亦短于ODN組；熱缺血時(shí)間腔鏡組比ODN組稍增加。HLDN組切取的供腎血管長(zhǎng)度較ODN組短。術(shù)后1周內(nèi)腎功能均正常,無(wú)移植腎失功能。 結(jié)論： 腹腔鏡下取腎,尤其是后腹腔鏡下取腎,與開放活體取腎相比,是一種創(chuàng)傷小、手術(shù)時(shí)間短、并發(fā)癥少、術(shù)后恢復(fù)快的手術(shù)方式,是活體取腎的有效方法。
[Abstract]:Background: globally, the incidence of uremia is on the rise. According to statistics, about 100 per 1 million people suffer from uremia every year. There are about 1.3 million patients with end-stage uremia who need hemodialysis or kidney transplantation in China, and the rate is increasing by 20-300000 people a year. Renal transplantation is one of the main methods for the treatment of uremia. Compared with hemodialysis and peritoneal dialysis, renal transplantation can improve the quality of life and prolong the survival time of patients. There is no legislation on brain death in China. The (DCD) of cardiac death organ donation is still in its infancy, which is far from satisfying the clinical needs. As a result, the proportion of relative living donor kidney transplantation in many transplant centers in China is increasing. With the development of medical technology, retroperitoneal laparoscopic in vivo renal (RPLDN) has become the main method of renal biopsy in vivo. Energy efficiency control of intraoperative bleeding, protection of renal function, clinical results are good. The clinical value of (ODN) in retroperitoneal laparoscopic nephrectomy (RPLDN) was evaluated by comparing with traditional open live donor nephrectomy (RPLDN) and hand-assisted retroperitoneal laparoscopic nephrectomy (HLDN). Aim: to evaluate the clinical value of open live donor nephrectomy (ODN) and hand assisted retroperitoneal laparoscopic nephrectomy (HLDN) by comparing the clinical efficacy of (RPLDN) with that of conventional open live donor nephrectomy. Methods: from July 2003 to July 2013 in Qianfoshan Hospital of Shandong Province, a total of 207 donors and recipients of living donor kidney transplantation were selected, including 82 cases of ODN, 20 cases of HLD N, and 20 cases of RPLDN105. The operation was successful. The perioperative complications, operation time, estimated bleeding volume, conversion to open surgery rate, hot ischemia time, average hospitalization time and postoperative complication rate of renal transplant recipients were analyzed retrospectively. The related clinical data were obtained by means of patient case review, out-patient follow-up and telephone follow-up, and the safety and effectiveness of laparoscopic in vivo nephrectomy were evaluated by comparative study. Results: all of the three groups completed the operation successfully. The average operation time in the RPLDN group was shorter than that in the HLDN,ODN group (P0.05), the intraoperative bleeding volume in the RPLDN group was significantly less than that in the ODN group, and the postoperative hospital stay was shorter than that in the ODN group. Compared with ODN group, the length of donor blood vessels in HLD group was shorter than that in ODN group. The renal function was normal within 1 week after operation, and no renal function was lost after transplantation. Conclusion: compared with open living kidney extraction, laparoscopic nephrectomy, especially retroperitoneal laparoscopic nephrectomy, is a less invasive, shorter operative time, less complications, and rapid recovery after operation. It is an effective method to take kidney in vivo. [WT5 "HZ] conclusion:\?
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R699.2
本文編號(hào)：2434126
[Abstract]:Background: globally, the incidence of uremia is on the rise. According to statistics, about 100 per 1 million people suffer from uremia every year. There are about 1.3 million patients with end-stage uremia who need hemodialysis or kidney transplantation in China, and the rate is increasing by 20-300000 people a year. Renal transplantation is one of the main methods for the treatment of uremia. Compared with hemodialysis and peritoneal dialysis, renal transplantation can improve the quality of life and prolong the survival time of patients. There is no legislation on brain death in China. The (DCD) of cardiac death organ donation is still in its infancy, which is far from satisfying the clinical needs. As a result, the proportion of relative living donor kidney transplantation in many transplant centers in China is increasing. With the development of medical technology, retroperitoneal laparoscopic in vivo renal (RPLDN) has become the main method of renal biopsy in vivo. Energy efficiency control of intraoperative bleeding, protection of renal function, clinical results are good. The clinical value of (ODN) in retroperitoneal laparoscopic nephrectomy (RPLDN) was evaluated by comparing with traditional open live donor nephrectomy (RPLDN) and hand-assisted retroperitoneal laparoscopic nephrectomy (HLDN). Aim: to evaluate the clinical value of open live donor nephrectomy (ODN) and hand assisted retroperitoneal laparoscopic nephrectomy (HLDN) by comparing the clinical efficacy of (RPLDN) with that of conventional open live donor nephrectomy. Methods: from July 2003 to July 2013 in Qianfoshan Hospital of Shandong Province, a total of 207 donors and recipients of living donor kidney transplantation were selected, including 82 cases of ODN, 20 cases of HLD N, and 20 cases of RPLDN105. The operation was successful. The perioperative complications, operation time, estimated bleeding volume, conversion to open surgery rate, hot ischemia time, average hospitalization time and postoperative complication rate of renal transplant recipients were analyzed retrospectively. The related clinical data were obtained by means of patient case review, out-patient follow-up and telephone follow-up, and the safety and effectiveness of laparoscopic in vivo nephrectomy were evaluated by comparative study. Results: all of the three groups completed the operation successfully. The average operation time in the RPLDN group was shorter than that in the HLDN,ODN group (P0.05), the intraoperative bleeding volume in the RPLDN group was significantly less than that in the ODN group, and the postoperative hospital stay was shorter than that in the ODN group. Compared with ODN group, the length of donor blood vessels in HLD group was shorter than that in ODN group. The renal function was normal within 1 week after operation, and no renal function was lost after transplantation. Conclusion: compared with open living kidney extraction, laparoscopic nephrectomy, especially retroperitoneal laparoscopic nephrectomy, is a less invasive, shorter operative time, less complications, and rapid recovery after operation. It is an effective method to take kidney in vivo. [WT5 "HZ] conclusion:\?
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R699.2
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，本文編號(hào)：2434126
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