Hadjianastassiou V G, Johnson R J, Rudge C J, Mamode N
Directorate of Nephrology, Transplantation and Urology, Level 6, New Guy's House, Guy's Hospital, St. Thomas' Street, London SE1 9RT, UK.
Am J Transplant. 2007 Nov;7(11):2532-7. doi: 10.1111/j.1600-6143.2007.01975.x. Epub 2007 Sep 14.
The worldwide expansion of laparoscopic, at the expense of open, donor nephrectomy (DN) has been driven on the basis of faster convalescence for the donor. However, concerns have been expressed over the safety of the laparoscopic procedure. The UK Transplant National Registry collecting mandatory information on all living kidney donations in the country was analyzed for donations between November 2000 (start of living donor follow-up data reporting) to June 2006 to assess the safety of living DN, after the recent introduction of the laparoscopic procedure in the United Kingdom. Twenty-four transplant units reported data on 2509 donors (601 laparoscopic, 1800 open and 108 [4.3%] unspecified); 46.5% male; mean donor age: 46 years. There was one death 3 months postdischarge and a further five deaths beyond 1 year postdischarge. The mean length of stay was 1.5 days less for the laparoscopic procedure (p < 0.001). The risk of major morbidity for all donors was 4.9% (laparoscopic = 4.5%, open = 5.1%, p = 0.549). The overall rate of any morbidity was 14.3% (laparoscopic = 10.3%, open = 15.7%, p = 0.001). Living donation has remained a safe procedure in the UK during the learning curve of introduction of the laparoscopic procedure. The latter offers measurable advantages to the donor in terms of reduced length of stay and morbidity.
以开放供体肾切除术为代价，腹腔镜供体肾切除术在全球范围内的扩张是基于供体更快的康复。然而，人们对腹腔镜手术的安全性表示担忧。分析了英国移植国家登记处收集的该国所有活体肾捐赠的强制性信息，这些捐赠发生在2000年11月（活体供体随访数据报告开始）至2006年6月之间，以评估在英国最近引入腹腔镜手术后活体供体肾切除术的安全性。24个移植单位报告了2509名供体的数据（601例腹腔镜手术、1800例开放手术和108例[4.3%]未指明）；46.5%为男性；供体平均年龄：46岁。出院后3个月有1例死亡，出院后1年以上另有5例死亡。腹腔镜手术的平均住院时间缩短了1.5天（p<0.001）。所有供体发生严重并发症的风险为4.9%（腹腔镜手术=4.5%，开放手术=5.1%，p=0.549）。任何并发症的总体发生率为14.3%（腹腔镜手术=10.3%，开放手术=15.7%，p=0.001）。在英国引入腹腔镜手术的学习曲线期间，活体捐赠仍然是一种安全的手术。就缩短住院时间和降低并发症发生率而言，后者为供体提供了可衡量的优势。
