【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)的開展時間比較早,技術(shù)成熟,已在國內(nèi)外廣泛應(yīng)用,而RLDN作為新興的手術(shù)方式,在我國應(yīng)用少。本文探究三種術(shù)式對供、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等統(tǒng)計學(xué)方法對三組資料的各項數(shù)據(jù)進行分析對比。結(jié)果:RLDN組、LDN組、ODN組44例手術(shù)均獲得成功,無術(shù)中中轉(zhuǎn)。RLDN組(178± 19.24 s)及 LDN 組(164.09±24.58 s)供腎熱缺血時間較 ODN 組(40.36±9.99 s)長(P=0.00,P=0.00);RLDN 組(31.6±2.41h)、LDN 組(34.36±6.04h)下床時間較 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)時間、術(shù)中出血量、并發(fā)癥發(fā)生率、術(shù)后進食時間三者無統(tǒng)計學(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,腹腔鏡手術(shù)及機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)時間短、能夠早期恢復(fù)正常的生活與活動等優(yōu)點。
[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：2508657