Ismail Hazem R, Flechner Stuart M, Kaouk Jihad H, Derweesh Ithaar H, Gill Inderbir S, Modlin Charles, Goldfarb David, Novick Andrew C
Section of Renal Transplantation, Laparoscopic, and Minimally Invasive Surgery, Glickman Urological Institute/Transplant Center, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
Transplantation. 2005 Oct 27;80(8):1124-7. doi: 10.1097/01.tp.0000179109.51593.87.
We reviewed our experience with simultaneous single incision bilateral native nephrectomy and renal transplantation in 11 patients (Group 1), compared to seven recipients who underwent staged laparoscopic bilateral nephrectomy followed by kidney transplantation (Group 2). Mean age, donor source, sex, cause of ESRD, and specimen size were similar in both groups (P=0.1). All Group 2 patients and 9 of 11 Group 1 patients had autosomal-dominant polycystic kidney disease. Perioperative Group 1 complications included: bowel injury, transplant urine leak, necrotic pancreatitis, delayed bowel movement, and severe shoulder pain secondary to diaphragmatic irritation. Seven (63.6%) Group 1 patients required an additional surgical procedure: midline incisional hernia, repair ureteral fistula, and repair enterocutaneous fistula. One Group 1 patient lost his graft secondary to bowel injury and intra-abdominal sepsis. No major complications, reoperations, or graft loss occurred in Group 2. For simultaneous bilateral native nephrectomy and kidney transplantation, over 60% of patients required an additional surgical procedure. Laparoscopic bilateral nephrectomy followed by kidney transplantation is a safe and feasible alternative.
我们回顾了11例患者（第1组）同期单切口双侧自体肾切除术及肾移植的经验，并与7例接受分期腹腔镜双侧肾切除术然后进行肾移植的受者（第2组）进行了比较。两组患者的平均年龄、供体来源、性别、终末期肾病病因及标本大小相似（P = 0.1）。第2组所有患者及11例第1组患者中的9例患有常染色体显性多囊肾病。第1组围手术期并发症包括：肠损伤、移植肾尿液漏、坏死性胰腺炎、排便延迟以及因膈肌刺激引起的严重肩部疼痛。7例（63.6%）第1组患者需要再次进行手术：中线切口疝修补、输尿管瘘修补及肠皮肤瘘修补。1例第1组患者因肠损伤及腹腔内感染而移植肾失功。第2组未发生重大并发症、再次手术或移植肾丢失。对于同期双侧自体肾切除术及肾移植，超过60%的患者需要再次进行手术。腹腔镜双侧肾切除术然后进行肾移植是一种安全可行的替代方法。
