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| 中国首例单孔多通道经腹腹腔镜活体供肾切取术 |
| 王林辉1△,杨庆1△,刘冰1,吴震杰1,肖成武1,侯炯2,盛夏1,王利丽2,黄燕2,罗文彬1,陈伟1,王承1,陈楚2,罗睿1,肖亮1,程欣1,孙颖浩1* |
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(1. 第二军医大学长海医院泌尿外科,上海 200433
2. 第二军医大学长海医院麻醉科,上海 200433
△共同第一作者
*通信作者) |
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| 摘要: |
| 目的全面进行相关术前评估并取得患者知情同意后尝试进行中国首例单孔多通道经腹腹腔镜活体供肾切取术,探讨该手术的可行性和安全性,总结操作经验。方法2011年11月9日,我科完成1例单孔多核通道(TriPortTM)经腹腹腔镜下活体供肾(左侧)切取术。供者,女,59岁,体质指数(BMI) 21.6 kg/m2,术前血肌酐45 μmol/L。术前核素(99m Tc-DTPA)肾功能检查:左肾50 ml/min,右肾56 ml/min。受者,男,41岁,BMI 19.5 kg/m2,与供者为母子关系,术前血肌酐1 446 μmol/L,因“慢性肾功能不全(肾衰竭期)”拟行肾移植术。取脐水平线上方经腹直肌纵行切口约5 cm,供肾动静脉及肾脏完全游离后,在髂血管水平离断输尿管和生殖静脉,将肾脏装入取物袋(EndoCatchTM Bag),分别离断肾脏动静脉后,迅速将标本经原切口取出。结果在不增加任何额外切口的情况下顺利完成手术,手术时间210 min,术中出血50 ml,热缺血时间3.8 min。供肾动脉长度3.6 cm,静脉长度4.5 cm,输尿管长度13 cm。皮肤切口关闭时长度为5 cm。供肾移植术中再通血流后,色泽良好,20 s后即有尿液排出。供者术后第1天、第2天、第3天视觉模拟疼痛评分分别为2.5/10、1/10、0/10,术后未使用任何止痛药物,第4天出院,无任何术中或术后并发症。受者术后12 h、24 h、2 d、3 d、4 d、5 d、6 d、7 d、出院前、术后1个月血肌酐分别为:475、282、148、145、117、100、103、98、80、84 μmol/L,恢复顺利,术后第10天出院。结论初步经验表明单孔多通道经腹腹腔镜下活体供肾切取术安全、可行、有效。术后供者疼痛轻,恢复快,切口小,具有良好临床应用前景,但目前完成的病例数较少,仍需进一步临床经验积累。 |
| 关键词: 肾移植 单孔腹腔镜手术 活体供者 肾切除术 |
| DOI：10.3724/SP.J.1008.2011.01329 |
| 投稿时间：2011-11-10修订日期：2011-11-25 |
| 基金项目:上海市市级医院新兴前沿技术联合攻关项目(SHDC12010115), 军队临床高新技术重大项目(2010gxjs057),上海市重点学科项目. |
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| Transperitoneal laparoendoscopic single-site (LESS) live donor nephrectomy: the first clinical case in China |
| WANG Lin-hui1△, YANG Qing1△, LIU Bing1, WU Zhen-jie1, XIAO Cheng-wu1, HOU Jiong2, SHENG Xia1, WANG Li-li2, HUANG Yan1, LUO Wen-bin1, CHEN Wei1, WANG Cheng1, CHEN Chu2, LUO Rui1,XIAO Liang1, CHENG Xin1, SUN Ying-hao1* |
(1. Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
2. Department of Anesthesiology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
△Co-first authors.
*Corresponding author.) |
| Abstract: |
| ObjectiveTo summarize out experience in the first case of transperitoneal laparoendoscopic single-site live donor nephrectomy (LESS-DN) in mainland China and to assess its safety and feasibility. MethodsThe female donor was aged 59-year-old, with a body mass index(BMI) of 21.6 kg/m2 and a preoperative serum creatinine level of 45 μmol/L. Tc 99m-DTPA was used to determine the glomerular filtration rate (GFR). The preoperative unilateral renal function was 50 ml/min for the left side and 56 ml/min for the right side. Recipient was a 41-year-old male, with a BMI of 19.5 kg/m2 and a preoperative serum creatinine level of 1,446 μmol/L, and who was to receive transplantation due to chronic renal dysfunction(renal failure stage). On Nov. 9th, 2011, the LESS-DN was performed via a multi-channel TriPortTM (Advanced Surgical Concepts, Wicklow, Ireland) through a 5 cm skin incision at our institute. The dissection of the kidney was facilitated with the standard laparoscopic instruments at all the steps. The renal artery and the renal vein were skeletonized after the adrenal vein and the lumber vein, if any, were clipped. The ureterogonadal packet was left en bloc and transected at the level when crossing the common iliac vessels. The kidney was entrapped, and the mouth of the bag loosely cinched around the intact renal artery and vein. The renal artery and the vein were separated. The pre-entrapped kidney was extracted through the original incision after generous cranial and caudal extension of the rectus fascia incision. ResultsThe procedure was smoothly completed without any extra skin incision. The operating time was 210 min, with an estimated blood loss of 50 ml, and a warm ischemia time of 3.8 min. The lengths of harvested renal artery, vein and ureter were 3.6 cm, 4.5 cm and 13 cm, respectively. The length of skin incision at closure was 5 cm. Allograft functioned immediately on transplantation. Donor Visual Analog Pain Scores at postoperative day 1, 2 and 3 were 2.5/10, 1/10, and 0/10, respectively. The recovery of the donor was uneventful and she was discharged on the 4th postoperative day. Postoperative serum creatinine levels of the recipient at 12 h, 24 h, 2 d, 3 d, 4 d, 5 d, 6 d, 7 d, discharge day, and 1 month postoperatively were 475, 282, 148, 145, 117, 100, 103, 98, 80, and 84 μmol/L, respectively. He was discharged on the 10th day after transplantation. ConclusionOur initial experience shows that the laparoendoscopic single-site live donor nephrectomy is a safe, feasible and effective procedure. It has the clinical benefits of less pain, rapid recovery and good cosmesis, with an encouraging future. But more clinical experience needs to be accumulated. |
| Key words: kidney transplantation laparoendoscopic single-site surgery living donors nephrectomy |
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