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目的 探讨后腹腔镜下活体供肾切取技术。 方法 2003年 12月至 2004年 6月通过后腹腔镜途径取活体供肾 6例,均取左肾。供受关系为:同胞兄弟姐妹 4例,父→子 1例,母→子1例。配型情况: 1例无错配, 2例 2点错配, 3例 3点错配。群体反应性抗体及淋巴细胞毒试验阴性。取侧卧位,用 3个穿刺点,经后腹腔游离肾脏,用直线切割器分别切断动脉和静脉,在两个穿刺点之间切 6~7cm的切口将肾取出,剪除动静脉上的钉子,灌注液灌注。供肾植于受体右髂窝。常规应用三联免疫抑制剂预防排斥反应。 结果 6例活体肾移植均获成功。移植肾术后第 1天尿量3500~6500ml,平均 5036ml;Cr227 ~1170μmol/L,平均 598μmol/L。术后 1个月时Cr平均值为 129μmol/L。随访 3~9个月肾功正常,均未发生排斥反应。 结论 后腹腔镜取肾术安全可行,对供体创伤小,但要求有熟练的腹腔镜和肾移植操作技术。
Objective To investigate the technique of retroperitoneal laparoscopic living donor nephrectomy. Methods From December 2003 to June 2004, 6 cases of living donor kidneys were obtained by retroperitoneal laparoscopic approach. Left kidney was obtained. For the relationship: siblings siblings in 4 cases, father → son in 1 case, mother → child in 1 case. Matching cases: 1 case without malfeasance, 2 cases 2 mismatch, 3 cases 3 mismatch. Group reactive antibody and lymphocyte toxicity test negative. Take the lateral position, with three puncture points, the free kidney after the abdominal cavity, with a linear cutter were cut off the arteries and veins, cutting between the two puncture 6 ~ 7cm incision to remove the kidney, cut off the nail on the arteriovenous , Perfusion fluid perfusion. Kidney implanted in the right iliac fossa of the recipient. Routine use of triple immunosuppressive agents to prevent rejection. Results 6 cases of living kidney transplantation were successful. On the first day after transplantation, the amount of urine output was 3500-6500ml, with an average of 5036ml; Cr227-1170μmol / L, with an average of 598μmol / L. The average Cr value at 1 month after operation was 129 μmol / L. Followed up for 3 to 9 months, normal renal function, no rejection occurred. Conclusions Retroperitoneal laparoscopic nephrectomy is safe and feasible, and has minimal trauma to the donor, but requires skilled laparoscopic and renal transplantation techniques.