Chung Eric, Grant Alexander B F, Hibberd Adrian D, Sprott Phillip
Department of Urology, Royal Newcastle Centre, Newcastle NSW, Australia.
BJU Int. 2007 Dec;100(6):1344-6. doi: 10.1111/j.1464-410X.2007.07126.x. Epub 2007 Sep 11.
To address donor attitudes and reasons for selecting either laparoscopic or open donor nephrectomy (LDN, ODN), as despite the increased interest in laparoscopic procedures, organ donation continues to lag behind the demand for organs, and many new initiatives have failed to reduce the gap.
This case series comprised a 10-year review of medical records and a transplant database on donor demographics, analgesic requirements, postoperative complications and length of hospital stay. A structured telephone interview was conducted for all live donors to evaluate donor awareness, reasons for selecting LDN and the psychosocial impact of DN on donors' rehabilitation.
Between 1995 and 2004, 38 LDN and 38 ODN were carried out; 70% were women in both groups, with a respective mean age of 44.4 and 47.1 years. Three LDNs were converted to ODN due to technical difficulties. The mean operative duration for LDN (194.8 min) was 78 min longer than for ODN (116.8 min). As expected, the mean analgesia requirement and length of hospital stay was less for LDN than ODN, by 55.4 mg of morphine equivalent and 2.3 days. Although all renal donors were aware of the option of LDN, one patient chose ODN due to safety concerns. The primary source of donor information was derived predominantly from the donor assessment process. The main reason for choosing LDN was the earlier return to work (54%), followed by less postoperative pain (33%). In general, there was minimal psychosocial impact after renal transplantation and the overall donor experience was very positive (85%).
LDN has remained a safe, less-invasive but effective technique for allograft procurement, with minimal morbidity. Overall, there is less postoperative pain and fewer surgical complications, and an earlier return to normal functioning. The level of satisfaction with the whole renal donation process was very positive, with minimal psychosocial impact.
探讨供体对于选择腹腔镜供肾切除术（LDN）或开放性供肾切除术（ODN）的态度及原因，尽管腹腔镜手术越来越受到关注，但器官捐献数量仍滞后于器官需求，许多新举措未能缩小这一差距。
本病例系列对医疗记录和移植数据库进行了为期10年的回顾，内容包括供体人口统计学资料、镇痛需求、术后并发症及住院时间。对所有活体供体进行了结构化电话访谈，以评估供体的认知、选择LDN的原因以及供肾切除术对供体康复的心理社会影响。
1995年至2004年间，共进行了38例LDN和38例ODN；两组中70%为女性，LDN组平均年龄44.4岁，ODN组平均年龄47.1岁。3例LDN因技术困难转为ODN。LDN的平均手术时间（194.8分钟）比ODN（116.8分钟）长78分钟。正如预期的那样，LDN的平均镇痛需求和住院时间比ODN少，吗啡等效剂量少55.4毫克，住院时间少2.3天。尽管所有肾供体都知晓LDN这一选择，但有1例患者因安全担忧选择了ODN。供体信息的主要来源主要是供体评估过程。选择LDN的主要原因是能更早重返工作岗位（54%），其次是术后疼痛较轻（33%）。总体而言，肾移植术后心理社会影响极小，供体的整体体验非常积极（85%）。
LDN仍然是一种安全、侵入性较小但有效的同种异体肾获取技术，发病率极低。总体而言，术后疼痛较轻，手术并发症较少，能更早恢复正常功能。对整个肾捐献过程的满意度非常高，心理社会影响极小。
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