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后腹腔镜供肾切取术的经验学习曲线及术中并发症的相关危险性分析

Learning Curve of Retroperitoneal Laparoscopic Donor Nephrectomy and Risk Analysis of Intraoperative Complications QIU Yang, SONG Tu-run, RAO Zheng-sheng, et al〗(547)WTDiagnostic Value of Immunofixation Electrophoresis and KAP/LAM Ratio in Multiple Myeloma Patients withRenal Injury

  • 摘要: 目的 建立后腹腔镜供肾切取术的学习曲线,并评估供者术中出现并发症的危险因素。方法 选择2009年4月至2014年4月在我院实施的527例后腹腔镜活体供肾切取术的供者为研究对象。根据平均手术时间研究学习曲线,并根据学习曲线将供者分为两组:学习曲线组(组1),后学习曲线组(组2)。收集和分析两组供者的围术期相关数据。结果 本组527例后腹腔镜活体供肾切取术的手术时间平均为(88.4±38.07) min。学习曲线研究显示经过100例的手术学习,手术时间从约130 min下降至约90 min。组1的手术时间、总体并发症、严重并发症发生率均高于组2。移植医师本次术前已完成手术例数与本次手术时间负相关,而供者体质量指数(BMI)、术中出现并发症与手术时间正相关。术中并发症发生率为1.90%,体质量指数(BMI)与术中并发症的发生呈正相关。学习曲线完成前,供肾动脉数量及供肾侧别并不影响手术时间;但学习曲线完成后,右侧供肾及肾动脉数量与手术时间正相关。结论 腹腔镜供肾切取术安全有效,并发症率低。本研究显示完成学习曲线需要100例,完成学习曲线后手术时间及并发症均明显下降。

     

    Abstract: Objective To investigate the learning curve of retroperitoneal laparoscopic donor nephrectomy (LDN) and evaluate the risk factors of intraoperative complications with data from a single center. Methods We evaluated perioperative data of 527 consecutive kidney donors who received retroperitoneal LDN between April 2009 and April 2014. The patients were divided into two groups according to the learning curve which was determined by the operation time:group 1 (on the learning curve) and group 2 (learning curve completed). Results The mean operation time was (88.4±38.07) min. The asymptote of the surgeon’s learning curve for retroperitoneal LDN was achieved at the 100th case. The operation time and the incidence of intraoperative complications in group 1 were significantly higher than those of group 2. When cases completed, body mass index (BMI) and intraoperative complications were correlated to operative time. The incidence of intraoperative complications was 1.90% and BMI was correlated to the incidence of intraoperative complications. When the learning curve was completed, renal artery numbers and right kidney were found being correlated to operative time. Conclusion Retroperitoneal LDN is a safe and effective operation method with a low incidence of complications. Technical proficiency in retroperitoneal LDN could be achieved after 100 surgeries.

     

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