[供体肾切除术：与小切口开放手术相比，腹腔镜肾脏切除术后疲劳感减轻，生活质量更佳：盲法随机研究]

[Donor nephrectomy: less fatigue and better quality of life following laparoscopic kidney removal compared with an open procedure by mini-incision: blind randomised study].

作者信息

Kok N F M, Lind M Y, Hansson B M E, Pilzecker D, Mertens zur Borg I R A M, Knipscheer B C, Hazebroek E J, Dooper I M, Weimar W, Hop W C J, Adang E M M, van der Wilt G J, Bonjer H J, van der Vliet J A, Ijzermans J N M

机构信息

Erasmus MC, Postbus 2040, 3000 CA Rotterdam.

出版信息

Ned Tijdschr Geneeskd. 2007 Jun 16;151(24):1352-60.

PMID:17665628

Abstract

OBJECTIVE

Determining possible differences in living donor nephrectomy procedures: laparoscopy against mini-incision concerning discomfort to the donor and the maintenance of good graft function.

DESIGN

Blind randomized study.

METHOD

In two university medical centres, one hundred living kidney donors were randomly assigned to either total laparoscopic donor nephrectomy or mini-incision muscle-splitting open donor nephrectomy. Primary outcome was physical fatigue measured with the 'Multidimensional Fatigue Inventory' (MFI-20) during one-year follow-up. Secondary outcomes were physical function measured with the 'Short form-36' questionnaire, postoperative hospital stay, amount of pain, operating times and graft and patient survival.

RESULTS

Donors who underwent laparoscopy experienced less fatigue (difference: -1.3; 95% CI: -2.4 - (-0.1)) and physical function was better (difference: 6.2; 95% CI: 2.0-10.3) during one-year follow-up. Those donors who underwent laparoscopy required less morphine (16 mg versus 25 mg; p = 0.005) and the duration of hospital stay was shorter (3 versus 4 days; p = 0.003). The laparoscopic procedure resulted in a longer operation time (221 versus 164 min; p < 0.001) a longer first warm ischaemia time (6 versus 3 min; p < 0.001) and less blood loss (100 versus 240 ml; p < 0.001). Recipient renal function and one-year graft survival rates did not differ. The number of preoperative and postoperative complications did not differ significantly between both surgery techniques. Conversions did not occur.

CONCLUSION

Donor nephrectomy through laparoscopy led to less fatigue and a better quality of life compared with the open procedure. The safety factors for donors and recipients were comparable for both techniques. Laparoscopic donor nephrectomy is therefore the better surgical choice for kidney donor programmes with living donors.

摘要

目的

确定活体供肾肾切除术在手术方式上的可能差异：对比腹腔镜手术与小切口手术对供体的不适程度及对良好移植肾功能的维持情况。

设计

双盲随机研究。

方法

在两家大学医学中心，100名活体肾供体被随机分配接受完全腹腔镜供肾肾切除术或小切口肌肉劈开开放式供肾肾切除术。主要结局指标是在一年随访期间用“多维疲劳量表”（MFI - 20）测量的身体疲劳程度。次要结局指标包括用“简短健康调查问卷（SF - 36）”测量的身体功能、术后住院时间、疼痛程度、手术时间以及移植肾和患者的存活率。

结果

在一年随访期间，接受腹腔镜手术的供体疲劳程度更低（差异：-1.3；95%置信区间：-2.4 - （-0.1）），身体功能更好（差异：6.2；95%置信区间：2.0 - 10.3）。接受腹腔镜手术的供体所需吗啡量更少（16毫克对25毫克；p = 0.005），住院时间更短（3天对4天；p = 0.003）。腹腔镜手术导致手术时间更长（221分钟对164分钟；p < 0.001），首次热缺血时间更长（6分钟对3分钟；p < 0.001），失血量更少（100毫升对240毫升；p < 0.001）。受者肾功能和一年移植肾存活率无差异。两种手术技术的术前和术后并发症数量无显著差异。未发生中转手术。