Nanidis Theodore G, Antcliffe David, Kokkinos Constantinos, Borysiewicz Catherine A, Darzi Ara W, Tekkis Paris P, Papalois Vassilios E
Department of Biosurgery and Surgical Technology, Imperial College London, St Mary's Hospital, London, UK.
Ann Surg. 2008 Jan;247(1):58-70. doi: 10.1097/SLA.0b013e318153fd13.
The aim of this study was to compare laparoscopic versus open live donor nephrectomy using meta-analytical techniques.
Laparoscopic live donor nephrectomy has gained widespread acceptance and is increasingly performed. The body of evidence assessing the safety and efficacy of laparoscopic compared with established open techniques is growing; however, very few randomized control trials exist and individual studies often have small patient numbers with varying results. We combined the available raw data to strengthen the current literature in comparing these techniques.
A literature search was performed and comparative studies published between 1997 and 2006 of open versus laparoscopic donor nephrectomy were included. Outcomes evaluated were operative and warm ischemia times, blood loss, donor complications, length of hospital stay, time to return to work, and delayed graft function.
Seventy-three studies matched the selection criteria and included 6594 patients, 3751 (57%) had undergone laparoscopic surgery and 2843 (43%) open nephrectomy. The open nephrectomy group had shorter operative and warm ischemia times by 52 minutes (P < 0.001) and 102 seconds (P < 0.001), respectively. This did not translate into higher delayed graft function or graft loss rates between the 2 groups. Patients in the laparoscopic group had a shorter hospital stay and a faster return to work by 1.58 days (P < 0.001) and 2.38 weeks (P < 0.001), respectively. There was a significantly higher rate of overall donor complications in the open group (P = 0.007), a finding not reproduced in any subsequent sensitivity analyses. When only randomized control trials were considered, there were shorter operative times (P = 0.002) for the open group but nonsignificantly different warm ischemia times. In contrast to the main analysis there were no differences in the overall complication rate, postoperative analgesia, hospital stay, or time taken to return to work.
Laparoscopic nephrectomy in live donor transplantation is a safe alternative to the open technique. Although open nephrectomy may be associated with shorter operative and warm ischemia times, patients undergoing laparoscopic nephrectomy may benefit from a shorter hospital stay and faster return to work without compromising graft function.
本研究旨在采用荟萃分析技术比较腹腔镜与开放活体供肾切除术。
腹腔镜活体供肾切除术已得到广泛认可且实施越来越多。评估腹腔镜技术与成熟的开放技术相比的安全性和有效性的证据越来越多；然而，随机对照试验很少，且个别研究的患者数量往往较少，结果各异。我们合并现有原始数据以加强当前关于比较这些技术的文献。
进行文献检索，纳入1997年至2006年间发表的开放与腹腔镜供肾切除术的比较研究。评估的结果包括手术时间、热缺血时间、失血量、供体并发症、住院时间、恢复工作时间以及移植肾功能延迟。
73项研究符合入选标准，共纳入6594例患者，其中3751例（57%）接受了腹腔镜手术，2843例（43%）接受了开放肾切除术。开放肾切除术组的手术时间和热缺血时间分别短52分钟（P<0.001）和102秒（P<0.001）。但这并未导致两组间移植肾功能延迟或移植失败率更高。腹腔镜组患者的住院时间更短，恢复工作更快，分别缩短1.58天（P<0.001）和2.38周（P<0.001）。开放组的总体供体并发症发生率显著更高（P = 0.007），在任何后续敏感性分析中均未重现这一结果。仅考虑随机对照试验时，开放组的手术时间更短（P = 0.002），但热缺血时间无显著差异。与主要分析不同，总体并发症发生率、术后镇痛、住院时间或恢复工作时间方面没有差异。
腹腔镜肾切除术在活体供肾移植中是开放技术的一种安全替代方法。虽然开放肾切除术可能手术时间和热缺血时间较短，但接受腹腔镜肾切除术的患者可能受益于更短的住院时间和更快恢复工作，且不影响移植肾功能。
