Gill I S, Kaouk J H, Hobart M G, Sung G T, Schweizer D K, Braun W E
Section of Laparoscopic and Minimally Invasive Surgery, Department of Urology, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
J Urol. 2001 Apr;165(4):1093-8.
We report our experience with laparoscopic bilateral synchronous nephrectomy for giant symptomatic autosomal dominant polycystic kidney disease (ADPKD) and compare outcome data with open bilateral nephrectomy.
Since March 1998, 10 patients underwent bilateral synchronous laparoscopic nephrectomy for giant symptomatic ADPKD. A 3 port retroperitoneal laparoscopic approach was used to secure the renal hilum and mobilize the kidney. Intact specimen extraction was performed through a midline infraumbilical extraperitoneal incision. The patient was then repositioned for the contralateral retroperitoneoscopic nephrectomy, with the second specimen also delivered through the same infraumbilical incision. Data were retrospectively compared with 10 patients who had undergone bilateral synchronous open nephrectomy for ADPKD between 1981 and 1992.
Patients in the laparoscopic and open groups were comparable in regard to age (53 versus 47 years, p = 0.54) and Anesthesiologist Society of America class (3 versus 3, p = 0.84) but patients in the laparoscopic group were significantly more obese (body mass index 35.9 versus 23.8, p = 0.02). For comparable total specimen weights (3 versus 3 kg, p = 0.69) surgical time was longer in the laparoscopic group (4.4 versus 3.8 hours, p = 0.007). However, the laparoscopic group was superior in regard to blood loss (150 versus 325 cc, p = 0.05), postoperative requirement of nasogastric tube (10% versus 100%, p = 0.0001), narcotic analgesics (34.2 versus 120.4 mg. morphine sulfate equivalent, p = 0.03) and hospital stay (1.5 versus 9 days, p = 0.004). Complications occurred in 5 patients (50%) in the laparoscopic group and 4 (40%) in the open group (p = 0.66). No laparoscopic case was converted to open surgery.
Synchronous bilateral retroperitoneal laparoscopic nephrectomy for giant symptomatic adult polycystic kidney disease is feasible, safe and efficacious, and can be performed either before or after renal transplantation. Compared to open surgery, the laparoscopic approach results in significantly shorter hospital stay, decreased morbidity and quicker recovery. Laparoscopy is currently our technique of choice in this setting.
我们报告腹腔镜双侧同步肾切除术治疗有症状的巨大常染色体显性多囊肾病（ADPKD）的经验，并将结果数据与开放性双侧肾切除术进行比较。
自1998年3月以来，10例患者接受了腹腔镜双侧同步肾切除术治疗有症状的巨大ADPKD。采用三孔后腹腔镜入路来处理肾蒂并游离肾脏。完整标本通过脐下正中腹膜外切口取出。然后患者重新定位进行对侧后腹腔镜肾切除术，第二个标本也通过同一脐下切口取出。将数据与1981年至1992年间接受双侧同步开放性ADPKD肾切除术的10例患者进行回顾性比较。
腹腔镜组和开放手术组患者在年龄（53岁对47岁，p = 0.54）和美国麻醉医师协会分级（3级对3级，p = 0.84）方面具有可比性，但腹腔镜组患者明显更肥胖（体重指数35.9对23.8，p = 0.02）。对于可比的标本总重量（3千克对3千克，p = 0.69），腹腔镜组的手术时间更长（4.4小时对3.8小时，p = 0.007）。然而，腹腔镜组在失血（150毫升对325毫升，p = 0.05）、术后鼻胃管需求（10%对100%，p = 0.0001）、麻醉性镇痛药（34.2毫克对120.4毫克硫酸吗啡当量，p = 0.03）和住院时间（1.5天对9天，p = 0.004）方面更具优势。腹腔镜组5例患者（50%）发生并发症，开放手术组4例患者（40%）发生并发症（p = 0.66）。没有腹腔镜手术病例转为开放手术。
腹腔镜双侧同步后腹腔镜肾切除术治疗有症状的巨大成人多囊肾病是可行、安全且有效的，可在肾移植之前或之后进行。与开放手术相比，腹腔镜手术入路可显著缩短住院时间、降低发病率并加快恢复。目前在这种情况下腹腔镜手术是我们的首选技术。
