不同方式活体供肾切取术的安全性和有效性对比分析

发布时间：2019-07-01 17:13

【摘要】：目的:开放活体供肾切取术(open living donor nephrectomy,ODN)、腹腔镜下活体供肾切取术(laparospic living donor nephrectomy,LDN)和机器人辅助腹腔镜下活体供肾切取术(robotic-assisted living donor nephrectomy,RLDN)是目前活体供肾切取的3种主要方式。开放手术和腹腔镜下供肾切取术的开展时间比较早,技术成熟,已在国内外广泛应用,而RLDN作为新兴的手术方式,在我国应用少。本文探究三种术式对供、受者的手术安全性和有效性。方法:回顾性分析2010年01月至2017年03月于南京鼓楼医院泌尿外科行活体供肾切取术的供者及受者44组,其中5例供者行机器人辅助腹腔镜下活体供肾切取术;11例供者行传统腹腔镜下活体供肾切取术;28例供者行开放式活体供肾切取术。记录所有供者的临床、影像及术后随访资料,采用方差分析以及卡方检验等统计学方法对三组资料的各项数据进行分析对比。结果:RLDN组、LDN组、ODN组44例手术均获得成功,无术中中转。RLDN组(178± 19.24 s)及 LDN 组(164.09±24.58 s)供肾热缺血时间较 ODN 组(40.36±9.99 s)长(P=0.00,P=0.00);RLDN 组(31.6±2.41h)、LDN 组(34.36±6.04h)下床时间较 ODN 组(41.46±11.12h)早(P=0.039,P=0.043);RLDN 组(5.6±0.55 天)住院时间较 LDN 组(9.27±2.37 天)、ODN组(9.71±2.28天)短(P=0.001;P=0.003);RLDN组及LDN组手术切口长度小于ODN组(7.8±0.84cm;8.55± 1.04cm;17.46± 1.6cm)(P=0.000,P=0.001)。RLDN 组及 LDN 组术后疼痛药物使用时间较ODN组短(3.2±0.84天;4.64± 1.36天;8.61 ±2.01天)(P=0.003,P=0.001)。手术时间、术中出血量、并发症发生率、术后进食时间三者无统计学差异。供体出院后工作生活均未出现受影响情况,受体术后未出现移植物功能异常。结论:RLDN、LDN的安全性与有效性与ODN相当,腹腔镜手术及机器人辅助腹腔镜手术具有创伤小、术后疼痛轻、疤痕不明显、康复时间短、能够早期恢复正常的生活与活动等优点。
[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 卤24.58s) was longer than that in ODN group (40.36 卤9.99s) (P 鈮，

本文编号：2508657