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手助后腹腔镜和开放活体供肾切取术的临床分析

Clinical analysis of hand-assisted retroperitoneoscopicand open living donor nephrectomy
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摘要 目的:比较手助后腹腔镜活体供肾切取术(HRPLDN)和开放活体供肾切取术(ODN)临床效果和安全性。方法:回顾性分析兰州大学第二医院2008年1月-2018年1月同期行HRPLDN 43例和ODN 47例患者资料,比较供者手术时间、热缺血时间、动静脉长度、输尿管长度、切口长度、出血量和围手术期并发症,比较术后24 h尿量、术后3 d内需用止痛药、住院时间和术后并发症发生的情况,比较以术后1周、1个月和3个月为时间点统计的肾功能指标,随访供、受者恢复情况。结果:90例供者手术均顺利完成,移植手术均获成功,HRPLDN组无术中转开放者,HRPLDN组和ODN组热缺血时间为(92.2±17.5)s vs.(80.2±16.3)s;出血量为(67.9±26.1)mLvs.(80.0±25.6)mL;切口长度为(9.2±1.0)cm vs.(13.3±1.6)cm;术后住院时间为(5.7±1.7)d vs.(6.8±2.1)d;术后3 d需止痛患者分别为1和8例,两组上述数据比较均差异有统计学意义(P<0.05)。手术时间、动静脉长度、输尿管长度和术后24 h尿量均差异无统计学意义(P>0.05),术后7 d、1个月及3个月肌酐水平均差异无统计学意义(P>0.05)。HRPLDN组术后切口脂肪液化1例,ODN组术后切口脂肪液化2例,切口感染1例。HRPLDN组和ODN组受者发生急性排斥反应分别为2和3例,发生移植肾功能延迟恢复各1例,其余受者肾功能均恢复良好。结论:HRPLDN与ODN均安全可靠,HRPLDN较ODN创伤小、出血少、美容效果好,缩短了住院时间,可替代ODN作为首选的治疗手段。 Objective:To compare the clinical efficacy and safety of hand-assisted retroperitoneoscopic live do?nor nephrectomy(HRPLDN)and open living donor nephrectomy(ODN).Methods:The clinical data of 43 patients with HRPLDN and 47 patients with ODN in the Second Hospital of Lanzhou University from January 2008 to Janu?ary 2018 were retrospectively analyzed.The donor’s operation time,warm ischemia time,arteriovenous length,ure?ter length,incision length and bleeding volume and perioperative complication were compared.The 24 h urine vol?ume,painkillers within 3 days after surgery,hospitalization time and postoperative complications were also com?pared.At the same time,the renal function indicators and the recovery of donors and recipients at 1 st week,1 st month and 3 rd month after surgery were compared.Results:All the surgical operations of 90 donors and all transplan?tations were performed successfully.There was no intraoperative conversion to open surgery in the HRPLDN group,and the time of warm ischemia in HRPLDN group and ODN group was(92.2±17.5)s vs.(80.2±16.3)s respective?ly with significant difference(P<0.05).The bleeding volume and incision length in HRPLDN group and ODN group were(67.9±26.1)vs.(80.0±25.6)mL and(9.2±1.0)vs.(13.3±1.6)cm respectively,with significant difference(P<0.05).Postoperative hospital stay in HRPLDN group and ODN group was(5.7±1.7)vs.(6.8±2.1)days,with significant difference(P<0.05).Postoperative analgesia at 3 rd day was given for 1 case and 8 cases in HRPLDN group and ODN group respectively,with the significant difference(P<0.05).There was no significant difference in operative time,arteriovenous length,length of ureter and urine volume at 24 h after operation(P>0.05).There was no significant difference in creatinine levels at 7 th,1 st and 3 rd month after operation(P>0.05).In the HRPLDN group,there was 1 case of incision fat liquefaction.In the ODN group,incision fat liquefaction oc?curred in 2 cases and incision infection in 1 case.The number of acute rejection in the HRPLDN gr
作者 郭霜 李选鹏 满江位 姜春倩 牛纪平 韩渊明 付生军 杨立 GUO Shuang;LI Xuanpeng;MAN Jiangwei;JIANG Chunqian;NIU Jiping;HAN Yuanming;FU Shengjun;YANG Li(Department of Urology,Lanzhou University Institute of Urology,Gansu Nephron-Urological Clinical Center,Gansu Provincial Key Laboratory of Urological System Diseases,Lanzhou Univer?sity Second Hospital,Lanzhou 730030,China;Department of Pediatrics,Lanzhou University Sec?ond Hospital)
出处 《微创泌尿外科杂志》 2019年第1期1-6,共6页
基金 甘肃省自然科学基金(17JR5RA237).
关键词 手助 后腹腔镜 开放 活体供肾切取术 hand-assisted retroperitoneoscopy open living donor nephrectomy
作者简介 通信作者:杨立,professoryangli@163.com.
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