發(fā)布時(shí)間：2019-07-01 17:13

【摘要】：目的:開放活體供腎切取術(shù)(open living donor nephrectomy,ODN)、腹腔鏡下活體供腎切取術(shù)(laparospic living donor nephrectomy,LDN)和機(jī)器人輔助腹腔鏡下活體供腎切取術(shù)(robotic-assisted living donor nephrectomy,RLDN)是目前活體供腎切取的3種主要方式。開放手術(shù)和腹腔鏡下供腎切取術(shù)的開展時(shí)間比較早,技術(shù)成熟,已在國(guó)內(nèi)外廣泛應(yīng)用,而RLDN作為新興的手術(shù)方式,在我國(guó)應(yīng)用少。本文探究三種術(shù)式對(duì)供、受者的手術(shù)安全性和有效性。方法:回顧性分析2010年01月至2017年03月于南京鼓樓醫(yī)院泌尿外科行活體供腎切取術(shù)的供者及受者44組,其中5例供者行機(jī)器人輔助腹腔鏡下活體供腎切取術(shù);11例供者行傳統(tǒng)腹腔鏡下活體供腎切取術(shù);28例供者行開放式活體供腎切取術(shù)。記錄所有供者的臨床、影像及術(shù)后隨訪資料,采用方差分析以及卡方檢驗(yàn)等統(tǒng)計(jì)學(xué)方法對(duì)三組資料的各項(xiàng)數(shù)據(jù)進(jìn)行分析對(duì)比。結(jié)果:RLDN組、LDN組、ODN組44例手術(shù)均獲得成功,無(wú)術(shù)中中轉(zhuǎn)。RLDN組(178± 19.24 s)及 LDN 組(164.09±24.58 s)供腎熱缺血時(shí)間較 ODN 組(40.36±9.99 s)長(zhǎng)(P=0.00,P=0.00);RLDN 組(31.6±2.41h)、LDN 組(34.36±6.04h)下床時(shí)間較 ODN 組(41.46±11.12h)早(P=0.039,P=0.043);RLDN 組(5.6±0.55 天)住院時(shí)間較 LDN 組(9.27±2.37 天)、ODN組(9.71±2.28天)短(P=0.001;P=0.003);RLDN組及LDN組手術(shù)切口長(zhǎng)度小于ODN組(7.8±0.84cm;8.55± 1.04cm;17.46± 1.6cm)(P=0.000,P=0.001)。RLDN 組及 LDN 組術(shù)后疼痛藥物使用時(shí)間較ODN組短(3.2±0.84天;4.64± 1.36天;8.61 ±2.01天)(P=0.003,P=0.001)。手術(shù)時(shí)間、術(shù)中出血量、并發(fā)癥發(fā)生率、術(shù)后進(jìn)食時(shí)間三者無(wú)統(tǒng)計(jì)學(xué)差異。供體出院后工作生活均未出現(xiàn)受影響情況,受體術(shù)后未出現(xiàn)移植物功能異常。結(jié)論:RLDN、LDN的安全性與有效性與ODN相當(dāng),腹腔鏡手術(shù)及機(jī)器人輔助腹腔鏡手術(shù)具有創(chuàng)傷小、術(shù)后疼痛輕、疤痕不明顯、康復(fù)時(shí)間短、能夠早期恢復(fù)正常的生活與活動(dòng)等優(yōu)點(diǎn)。
[Abstract]:Aim: open living donor kidney resection (open living donor nephrectomy,ODN), laparoscopic living donor kidney resection (laparospic living donor nephrectomy,LDN) and robot assisted laparoscopic living donor kidney resection (robotic-assisted living donor nephrectomy,RLDN) are the three main methods of living donor kidney resection. Open surgery and laparoscopic donor kidney resection have been developed early and technologically mature, and have been widely used at home and abroad, while RLDN, as a new surgical method, is rarely used in China. In this paper, the safety and effectiveness of three surgical methods for donors and recipients were investigated. Methods: from January 2010 to March 2017, 44 donors and recipients underwent living donor kidney resection in the Department of Urology of Nanjing Gulou Hospital. Among them, 5 donors underwent robot assisted laparoscopic living donor kidney resection, 11 donors underwent traditional laparoscopic living donor kidney resection, and 28 donors underwent open living donor kidney resection. The clinical, imaging and postoperative follow-up data of all donors were recorded, and the data of the three groups were analyzed and compared by means of variance analysis and chi-square test. Results: 44 cases in RLDN group, LDN group and ODN group were successfully operated. The warm ischemia time of donor kidney in RLDN group (17819.24s) and LDN group (164.09 鹵24.58s) was longer than that in ODN group (40.36 鹵9.99s) (P 鈮，

本文編號(hào)：2508657