气腹对机器人辅助腹腔镜下肾移植术后移植肾功能的影响

Effect of pneumoperitoneum on renal function after robotic-assisted laparoscopic kidney transplantation

    摘要
  • 摘要:
    目的 探讨机器人辅助腹腔镜下肾移植术（RAKT）气腹压力对移植肾功能的影响。
    方法 回顾性分析243例肾移植受者资料，分为开放肾移植术（OKT）组105例，RAKT组138例，RAKT组再根据气腹压分为13 mmHg组（67例）和7 mmHg组（71例）。对比3组间供者资料、受者术前一般资料、术中数据和术后恢复情况。分析RAKT组受者，腹腔镜下超声测量的移植肾主动脉、段动脉、叶间动脉和静脉流速。
    结果 各组供者类型差异有统计学意义（P＜0.05），其余供者资料及受者术前一般资料差异均无统计学意义（均为P＞0.05）。各组受者术后30 d、1年血清肌酐和并发症差异无统计学意义（P＞0.05）。OKT组、7 mmHg组尿量多于13mmHg组；RAKT两组失血量、住院时间组少于OKT组，手术时间长于OKT组（均为P＜0.05）。RAKT两组间手术时间、失血量、住院时间差异无统计学意义（均为P＞0.05）。13 mmHg气腹压力时移植肾血管流速比7 mmHg气腹压力均有下降，但差异无统计学意义（均为P＞0.05）。
    结论 可控的气腹压力对移植肾的血管流速影响有限，RAKT在适当的气腹压力下是一种安全、有效的手术方式，选择较低的气腹压力更有利于术后早期肾功能的恢复。

     

    Abstract:
    Objective To investigate the effect of pneumoperitoneum pressure during robotic-assisted kidney transplantation (RAKT) on the function of the transplant kidney.
    Methods The data of 243 kidney transplant recipients were retrospectively analyzed and divided into open kidney transplantation (OKT) group (n=105) and RAKT group (n=138). The RAKT group was further divided into 13 mmHg group (n=67) and 7 mmHg group (n=71) based on pneumoperitoneum pressure. The donor information, recipient's preoperative general data, intraoperative data, and postoperative recovery of the three groups were compared. In the RAKT group, the renal artery, segmental artery, interlobar artery, and venous flow velocity of the transplant kidney were measured using laparoscopic ultrasound.
    Results There was a statistically significant difference in donor types among the groups (P<0.05), while other donor information and recipient's preoperative general data showed no statistically significant differences (all P>0.05). There were no statistically significant differences in serum creatinine and complications at 30 days and 1 year postoperatively among the groups (all P>0.05). The OKT group and 7 mmHg group had more urine output than the 13 mmHg group; both RAKT groups had less blood loss and shorter hospital stays than the OKT group, and longer operation times than the OKT group (all P<0.05). There were no statistically significant differences in operation time, blood loss, and hospital stay between the two RAKT groups (all P>0.05). The vascular flow velocity of the transplant kidney decreased at 13 mmHg compared to 7 mmHg pneumoperitoneum pressure, but the differences were not statistically significant (all P>0.05).
    Conclusions Controllable pneumoperitoneum pressure has a limited impact on the vascular flow velocity of the transplanted kidney. RAKT is a safe and effective surgical method under appropriate pneumoperitoneum pressure, and choosing a lower pneumoperitoneum pressure is more conducive to the early recovery of renal function postoperatively.

     

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