目的 总结后腹腔镜下活体供肾切取术193例的经验,优化改进操作技术,使其更加标准化。方法 选择北京大学第三医院2003年12月至2016年2月行后腹腔镜下活体供肾切取术共193例,全身麻醉下,取腰部3个通道操作,彻底游离肾后,在肾下极7~8 cm处切断输尿管,用endo-cut或 hem-o-lok分别夹闭切断肾动静脉,迅速取出肾用4 ℃肾保存液进行灌注,然后将离体肾保存在冰盐水中准备移植,记录手术时间、出血量、并发症发生情况、供者和受者肾功能情况。结果 193例手术均获得成功,手术时间85 min(55~135 min),1例因出血手术中转开放。术中出血量60 mL(20~200 mL),所有供者均不需输血。供肾热缺血时间2.2 min(2~5 min)。发生供者并发症3例,均为术后肾区血肿,保守治疗均自行吸收,未见不良影响,其余供者均未见异常。供者术后住院5.7 d(4~9 d)。193例供者中162例得到随访,平均随访42个月(1~58个月),均未见异常。2例受者发生移植肾输尿管吻合口漏尿,经手术修补后痊愈;3例受者发生移植肾被膜下血肿。1例受者发生移植肾功能延迟恢复,其余受者肾功能恢复良好。供、受者随访期间肾功能均未见异常。结论 后腹腔镜下活体供肾切取术安全可靠,经不断技术改良后已经成熟和标准化,其应用前景广泛,但应由有经验的医生操作以预防并发症的发生。

Objective: To summarize our experience of retroperitoneal laparoscopic living donor nephrectomy, our continuous technical improvements and refinement of this skill and standardization of each procedure of this operation. Methods: Having approved by hospital ethical committee and local government administration, a total of 193 living donors underwent retroperitoneal laparoscopic living donor nephrectomy from Dec.2003 to Feb.2016 in our department. Under general anaesthesia, the operation was performed through 3 lumbar ports. After the kidney was liberated fully and the ureter was severed 7-8 cm under the lower pole of the kidney, the renal artery and vein were blocked with endo-cut or hem-o-lok separately and then severed. Then the kidney was taken out quickly and flushed with 4 ℃ kidney preserving fluid immediately, the donor kidneys were then preserved in iced saline until kidney transplantation. Clinical data about operation time, volume of blood loss, perioperative complications, renal function of both donors and recipients before and after operation were collected. Results: The 193 retroperitoneal laparoscopic living donor nephrectomy operations were successful with only one operation was converted to open living donor nephrectomy because of hemorrhage and unclear operation field during the operation. The average operation time was 85 min (55-135 min), the average blood loss was 60 mL (20-200 mL), and no donor needed blood transfusion during or after operation. Three donors were found to have hematoma of renal fossa after operation and none of them required further treatment. The average hospital stay after operation was 5.7 days (4-9 days). In the study, 162 donors were followed up for an average of 42 months (1-58 months) and they were all healthy. Two kidney recipients had urinary bladder anastomosis leakage after operation and both needed surgical repair, a new anastomosis of ureter and bladder were made. Three kidney recipients had kidney subcapsular hematoma but required no further treatment. One kidney recipient had delayed graft function and recovered finally and the renal function of other recipients were all normal. Renal function of both donors and recipients during the follow up period were normal. Conclusion: Retroperitoneal laparoscopic living donor nephrectomy is a safe and reliable technique, it may become a standardized operation for living kidney transplantation after continuous technical improvement. Precautions must be taken to avoid complications and a skilled hand is necessary for success.