Philosophe B, Kuo P C, Schweitzer E J, Farney A C, Lim J W, Johnson L B, Jacobs S, Flowers J L, Cho E S, Bartlett S T
Department of Surgery, University of Maryland, Baltimore 21201, USA.
Transplantation. 1999 Aug 27;68(4):497-502. doi: 10.1097/00007890-199908270-00009.
Laparoscopic live donor nephrectomy (LDN) is a recently developed procedure, the performance of which needs to be studied. Given the reported advantages in the donors, this study looks at graft outcome and ureteral complications in recipients of kidneys procured by open donor nephrectomy (ODN) versus LDN.
The LDN recipients consisted of 193 patients since 3/27/96. A total of 168 ODN recipients from 1991 to 1998 served as controls. Immunosuppression protocols were similar for both groups.
Two-year graft survival for LDN and ODN was 98% and 96%, respectively. Two-year patient survival for LDN and ODN was 98% and 97%, respectively. The incidence of delayed graft function and mean serum creatinine at 3 and 12 months was similar in both groups. However, the number of ureteral complications that required operative repair was significantly higher for LDN recipients compared to ODN recipients, 7.7% (n=15) vs. 0.6% (n=1) respectively (P=0.03). Ureteral stenting was required in an additional 3.1% (n=6) of LDN and 2.4% (n=4) of ODN (P=NS). There was, however, a learning curve with time. For the first 130 LDN patients, a total of 20 ureteral complications were recorded, whereas only one occurred in the more recent 63 patients (P=0.03).
The higher ureteral complication rate in LDN recipients has improved over time as technical causes have been identified. We have noted significant improvement in ureteral viability by using the endogastrointestinal anastomosis instrument on the ureter and peri-ureteral tissue. LDN is therefore an excellent alternative to ODN. Identification of hazards unique to this technique is critical before its broader application.
腹腔镜活体供肾切除术（LDN）是一项最近才开展的手术，其操作情况有待研究。鉴于该手术对供体有诸多已报道的优势，本研究观察了接受开放供肾切除术（ODN）与LDN获取的肾脏的受者的移植肾结局及输尿管并发症情况。
自1996年3月27日起，LDN受者共193例。1991年至1998年的168例ODN受者作为对照。两组的免疫抑制方案相似。
LDN和ODN的移植肾2年生存率分别为98%和96%。LDN和ODN的患者2年生存率分别为98%和97%。两组延迟移植肾功能的发生率以及3个月和12个月时的平均血清肌酐水平相似。然而，LDN受者中需要手术修复的输尿管并发症数量显著高于ODN受者，分别为7.7%（n = 15）和0.6%（n = 1）（P = 0.03）。另外，LDN组有3.1%（n = 6）、ODN组有2.4%（n = 4）的患者需要输尿管支架置入（P = 无显著差异）。不过，随着时间推移存在学习曲线。在前130例LDN患者中，共记录到20例输尿管并发症，而在最近的63例患者中仅发生1例（P = 0.03）。
随着技术问题得到明确，LDN受者较高的输尿管并发症发生率已随时间有所改善。我们注意到，通过使用消化道内吻合器械处理输尿管及输尿管周围组织，输尿管的活力有了显著改善。因此，LDN是ODN的一个极佳替代方案。在更广泛应用该技术之前，识别其独特的风险至关重要。
