Ratner L E, Montgomery R A, Maley W R, Cohen C, Burdick J, Chavin K D, Kittur D S, Colombani P, Klein A, Kraus E S, Kavoussi L R
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287-8611, USA.
Transplantation. 2000 Jun 15;69(11):2319-23. doi: 10.1097/00007890-200006150-00016.
Laparoscopic live donor nephrectomy offers advantages to the donor in terms of decreased pain and shorter recuperation. Heretofore no detailed analysis of the recipient of laparoscopically procured kidneys has been performed. The purpose of this study was to determine whether laparoscopic donor nephrectomy had any deleterious effect on the recipient.
A retrospective review was conducted of all live donor renal transplantations performed from January 1995 through April 1998. The control group received kidneys procured via a standard flank approach (Open). Rejection was diagnosed histologically. Creatinine clearance was calculated using the Cockroft-Gault formula.
A total of 110 patients received kidneys from laparoscopic (Lap) and 48 from open donors. One-year recipient (100% vs. 97.0%) and graft (93.5% vs. 91.1%) survival rates were similar for the Open and Lap groups, respectively. A similar incidence of vascular thrombosis (3.4% vs. 2.1%, P=NS) and ureteral complications (9.1% vs. 6.3%, P=NS) were seen in the Lap and Open groups, respectively. The incidence of acute rejection for the first month was 30.1% for the Lap group and 31.9% for the Open group (P=NS). The rate of decline of serum creatinine level in the early posttransplantation period was initially greater in the Open group, but by postoperative day 4 no significant difference existed. No difference was observed in allograft function long-term. The median length of hospital stay was 7.0 days for both groups.
Laparoscopic live donor nephrectomy does not adversely effect recipient outcome. The previously demonstrated benefits to the donor, and the increased willingness of individuals to undergo live kidney donation, coupled with the acceptable outcomes experienced by recipients of laparoscopically procured kidneys justifies the continued development and adoption of this operation.
腹腔镜活体供肾切除术在减轻供者疼痛和缩短恢复时间方面具有优势。此前尚未对通过腹腔镜获取肾脏的受者进行详细分析。本研究的目的是确定腹腔镜供肾切除术对受者是否有任何有害影响。
对1995年1月至1998年4月期间进行的所有活体供肾肾移植进行回顾性研究。对照组接受通过标准侧腹切口获取的肾脏（开放手术）。通过组织学诊断排斥反应。使用Cockcroft-Gault公式计算肌酐清除率。
共有110例患者接受了来自腹腔镜供者（Lap）的肾脏，48例接受了来自开放供者的肾脏。开放组和腹腔镜组的1年受者生存率（分别为100%对97.0%）和移植物生存率（分别为93.5%对91.1%）相似。腹腔镜组和开放组分别观察到相似的血管血栓形成发生率（3.4%对2.1%，P=无统计学意义）和输尿管并发症发生率（9.1%对6.3%，P=无统计学意义）。腹腔镜组第一个月的急性排斥反应发生率为30.1%，开放组为31.9%（P=无统计学意义）。移植后早期血清肌酐水平下降率最初在开放组较高，但到术后第4天无显著差异。长期来看，同种异体移植物功能无差异。两组的中位住院时间均为7.0天。
腹腔镜活体供肾切除术对受者结局无不利影响。先前已证明对供者有益，且个人进行活体肾捐赠的意愿增加，再加上腹腔镜获取肾脏的受者所经历的可接受结局，证明了该手术的持续发展和采用是合理的。
