后腹腔镜活体供肾切取术的临床应用
发布时间：2019-03-04 09:00
【摘要】：背景： 全球范围内,尿毒症的发病率不断上升。据统计,每一百万人口中每年约有100-150人发生尿毒症。我国现有需要血液透析或肾移植的终末期尿毒症患者约130万,并且以每年20-30万人的速度在增加。肾移植术是治疗尿毒症的主要方法之一,相对于血液透析及腹膜透析而言,能更好的提高患者的生存质量并能延长存活的时间,由于目前尸体供肾的严重缺乏,国内脑死亡尚未立法,心脏死亡器官捐献(DCD)刚刚起步,远远不能满足临床需要。正如此,亲属活体供肾肾移植在国内许多移植中心所占的移植比例不断升高。随着医疗技术的进步,后腹腔镜活体取肾(RPLDN)已成为活体取肾的主要方法,能效控制术中出血,保护肾脏功能,临床效果良好。本文通过与传统开放活体供肾切取术(ODN)和手助式后腹腔镜下供肾切取术(HLDN)的临床效果比较,评价后腹腔镜下供肾切取术(RPLDN)的临床价值。 目的： 通过与传统开放活体供肾切取术(ODN)和手助式后腹腔镜下供肾切取术(HLDN)的临床效果比较,评价后腹腔镜下供肾切取术(RPLDN)的临床价值。 方法： 选取山东省千佛山医院2003年7月至2013年7月间的共207例亲属活体肾移植供受者为研究对象,其中ODN82例,HLDN20例,RPLDN105例,手术均获得成功。通过对研究对象围手术期并发症、手术时间、估计出血量、中转开腹手术率、热缺血时间、平均住院时间、肾移植受者术后并发症发生率等指标进行回顾性分析。通过病案调阅、门诊随访、电话随访等方式获取相关临床资料,通过对比研究,评价腹腔镜活体取肾手术的安全性和有效性。 结果： 三组均成功完成手术,无中转开放手术者。RPLDN组平均手术时间较HLDN、ODN组短(P0.05)；术中失血量腔镜手术组明显少于ODN组,术后住院时间亦短于ODN组；热缺血时间腔镜组比ODN组稍增加。HLDN组切取的供肾血管长度较ODN组短。术后1周内肾功能均正常,无移植肾失功能。 结论： 腹腔镜下取肾,尤其是后腹腔镜下取肾,与开放活体取肾相比,是一种创伤小、手术时间短、并发症少、术后恢复快的手术方式,是活体取肾的有效方法。
[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:\?
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R699.2
本文编号：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:\?
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R699.2
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相关期刊论文 前3条
1 徐战平;王行环;郑祥光;杨浣情;刘久敏;高炜成;;后腹腔镜手术与传统开放手术在活体供肾切取术的临床应用[J];南方医科大学学报;2009年06期
2 赵豫波;石炳毅;蔡明;侯瑞鹏;裴向克;;亲属活体供肾移植30例临床分析[J];解放军医学杂志;2008年02期
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