Preliminary experience of robotic-assisted kidney transplantation in a single center
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摘要:
目的 探索机器人辅助肾移植（RAKT）的安全性、有效性及可行性。 方法 收集行肾移植术的16例患者资料，其中8例采用RAKT（RAKT组），接受同一供者对侧肾脏的8例患者采用开放肾移植术（OKT组）。对比两组受者围手术期结果及移植肾功能恢复情况。 结果 所有患者均成功完成手术，RAKT组无患者在术中转开放手术。RAKT组手术时间长于OKT（P=0.015）。两组受者术前血清肌酐及出院时血清肌酐差异无统计学意义（均为P＞0.05）。OKT组1例受者出现移植物功能延迟恢复（DGF），其余患者均未出现围手术期并发症。两组术后短期肾功能恢复差异无统计学意义（P＞0.05）。 结论 RAKT术后恢复与OKT相当，对于肾移植手术经验丰富的团队而言，RAKT是一种安全有效的手术方式，可以尝试开展。 Abstract:Objective To evaluate the safety, effectiveness and feasibility of robot-assisted kidney transplantation (RAKT). Methods Clinical data of 16 patients who underwent kidney transplantation were collected. Among them, 8 recipients received RAKT (RAKT group) and 8 cases underwent open kidney transplantation (OKT) with the contralateral kidney from the same donor (OKT group). Perioperative status and the recovery of renal allograft function were compared between two groups. Results All patients successfully completed the surgery. In the RAKT group, no patient was converted to open surgery. The operation time in the RAKT group was longer than that in the OKT group (P=0.015). No significant differences were observed in the serum creatinine levels before surgery and upon discharge between two groups (both P＞0.05). In the OKT group, one recipient developed delayed graft function (DGF), and the remaining recipients did not experience perioperative complications. No significant difference was noted in the short-term recovery of renal allograft function between two groups (P＞0.05). Conclusions Postoperative recovery of the recipients in the RAKT group is equivalent to that of their counterparts in the OKT group. RAKT is a safe and effective procedure for the team expertise in kidney transplantation. -
图 1 供肾包裹及受者体位
注：A图为使用双层无菌塑料肾袋包裹供肾；B图为RAKT术中患者体位。
Figure 1. Donor kidney encapsulation and position of recipient
图 2 RAKT手术过程
注：A图为建立肾巢；B图为右髂外血管骨骼化；C图为静脉吻合；D图为动脉吻合；E图为开放循环；F图为输尿管膀胱吻合；G图为完全腹膜外化；H图为部分腹膜外化。
Figure 2. Surgical procedures of RAKT
图 3 两组受者术后血清肌酐变化趋势
Figure 3. Trend of postoperative serum creatinine changes in two groups of recipients
表 1 两组受者一般资料及围手术期结果比较
Table 1. Comparison of general date and perioperative outcomes between recipients of two groups
指标 RAKT组（n=8） OKT组（n=8） P值 年龄（$\overline x $±s，岁） 40±14 50±10 0.120 性别（n） 1.000 男 8 7 女 0 1 是否透析（n） 1.000 是 6 7 否 2 1 透析时间（$\overline x $±s，月） 7.0（0.3,11.8） 8.5（1.8,15.8） 0.597 手术时间[M（P25,P75），min] 295（287，370） 242（189，285） 0.015 术中出血量[M（P25,P75），mL] 100（100，200） 100（100，138） 0.809 术后住院时间（$\overline x $±s，d） 15±3 15±4 0.787 术前血清肌酐（$\overline x $±s，μmol/L） 915±179 1 145±288 0.075 出院时血清肌酐（$\overline x $±s，μmol/L） 108±33 133±60 0.309 
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