Jones K W, Peters T G, Walker G W
Department of Surgery and the Jacksonville Transplant Center, Methodist Medical Center, University of Florida Health Science Center, Jacksonville 32209, USA.
Am Surg. 1999 Mar;65(3):197-204.
Of 133 consecutive renal transplants, 61 (46%) were living donor grafts recovered in an anterior-retroperitoneal approach. Donor demographics, operative-anesthetic care, length of stay (LOS), hospital charges, and complications were reviewed with donor and recipient follow-up of 4 to 40 months. Donors included 35 women and 26 men, ages 22 to 61 years (mean, 42.2); thirty-nine were living related and 22 were living unrelated donors. Pretransplant evaluation defined renal anatomy and function (minimal creatinine clearance, 75 cc/minute). Hospital admission occurred the morning of donation. Nephrectomy by the anterior-retroperitoneal approach (no rib resection) was followed by postoperative epidural pain control, early resumption of diet, progressive ambulation, and aggressive pulmonary care. Operating room time door-to-door averaged 2 hours, 43 minutes (range, 1 hour, 45 minutes-3 hours, 55 minutes). Donors were hospitalized for 2 (n = 7), 3 (n = 24), 4 (n = 19), and 5 to 8 (n = 11) days (mean LOS, 3.75; range, 2-8 days). The mean charge for donor hospitalization was $15,329 (range, $10,808-$29,579). One donor required transfusion; another was readmitted for wound drainage and pneumonia treated medically. All donors remain well with normal renal function. One early graft loss (3 days) occurred from arterial intimal dissection; all others gained life-sustaining function. Recipient (98%) and graft (92%) survival was excellent at 4 to 40 months. Anterior-retroperitoneal living donor nephrectomy is safe and effective, permitting hospital LOS of usually <4 days, early recovery, and no lasting complications. Excellent donor and recipient results from this procedure should compel critical assessment of techniques requiring more extensive operative exposure or more costly operating room and hospital approaches to donor surgical management.
在连续的133例肾移植中，61例（46%）是采用前后腹腔联合入路获取的活体供肾。对供者的人口统计学资料、手术麻醉护理、住院时间（LOS）、住院费用及并发症进行了回顾，供者和受者的随访时间为4至40个月。供者包括35名女性和26名男性，年龄22至61岁（平均42.2岁）；39例为亲属活体供者，22例为非亲属活体供者。移植前评估明确了肾脏的解剖结构和功能（肌酐清除率最低为75毫升/分钟）。供者于捐献当天上午入院。采用前后腹腔联合入路（不切除肋骨）进行肾切除，术后采用硬膜外镇痛、早期恢复饮食、逐步下床活动及积极的肺部护理。手术室从进室到出室的时间平均为2小时43分钟（范围为1小时45分钟至3小时55分钟）。供者住院2天（n = 7）、3天（n = 24）、4天（n = 19）和5至8天（n = 11）（平均住院时间3.75天；范围为2至8天）。供者住院的平均费用为15329美元（范围为10808美元至29579美元）。1例供者需要输血；另1例因伤口引流和肺炎再次入院接受药物治疗。所有供者肾功能正常，恢复良好。1例早期移植肾失功（3天）是由于动脉内膜剥离；其他所有移植肾均获得维持生命的功能。在4至40个月时，受者存活率为98%，移植肾存活率为92%。前后腹腔联合入路活体供肾肾切除术安全有效，通常住院时间<4天，恢复早，无持久并发症。该手术供者和受者的良好结果应促使对需要更广泛手术暴露或更昂贵的手术室及医院供者手术管理方法的技术进行批判性评估。
