Is There a New Alternative for a Safer Kidney Artery Ligation in Laparoscopic Donor Nephrectomy?
Is There a New Alternative for a Safer Kidney Artery Ligation in Laparoscopic Donor Nephrectomy?
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腹腔镜供体肾切除术中是否有更安全的肾动脉结扎的新替代方案？
DOI：
10.1089/lap.2016.0271
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发表时间：
2017
期刊：
影响因子：
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通讯作者：
Carmen González
中科院分区：
文献类型：
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作者：
R. Cabello;J. V. García;C. Quicios;Gonzalo Bueno;Carmen González
肾门的控制结扎和分割是腹腔镜活体肾切除术中的关键步骤。技术故障造成的大出血虽然很少发生，但可能会导致严重但可预防的发病或死亡。聚合物固定非贯穿夹在全球范围内用于腹腔镜肾切除术期间的肾蒂控制，但在腹腔镜活体供体肾切除术期间禁止使用它们来结扎肾动脉。腹腔镜吻合器是控制肾蒂的可靠贯穿系统。然而，订书机故障也不容忽视，高达1.7%。新型双柄（DS）钛固定非贯穿夹可以避免对聚合物固定夹的法律担忧，同时保留其大部分优点，不会出现腹腔镜吻合器中可能出现的技术故障。必须提出并探索新的替代方案，以达成泌尿外科界的一致意见。新的 DS 钛固定夹可能是向肾脏捐赠者的更安全手术迈出的一步，至少相当于用手绳来闭塞肾动脉。
Controlled ligation and division of the renal hilum are critical steps during laparoscopic living donor nephrectomy. Major hemorrhage from technical failure, although an infrequent occurrence, can cause significant, yet preventable, morbidity or death. Polymer-secured nontransfixion clips are used worldwide for renal pedicle control during laparoscopic nephrectomy, but their use is contraindicated for renal artery ligation during laparoscopic living donor nephrectomy. Laparoscopic staplers are reliable transfixion systems for controlling kidney pedicle. However, stapler malfunction is not negligible, reaching up to 1.7%. A new double shank (DS) titanium-secured nontransfixion clip can dodge legal concerns on polymer-secured clips, while maintaining most of their advantages, without technical failures that may be seen in laparoscopic staplers. New alternatives must be proposed and explored to reach an agreement of the urological community. The new DS-titanium-secured clips could be a step forward toward a safer surgery for kidney donors, at least equivalent to hand ties to occlude the renal artery.