Hung C J, Lin Y J, Chang S S, Chou T C, Chuang J P, Chung P Y, Lin Y S, Lee P C
Division of Transplantation, Department of Surgery, National Cheng-Kung University Hospital, Tainan, Taiwan.
Transplant Proc. 2008 Sep;40(7):2112-4. doi: 10.1016/j.transproceed.2008.07.047.
Despite the advantages of laparoscopic living donor nephrectomy (LDN), this technique is known to have a steep learning curve that makes worldwide adoption challenging, especially in institutions without a large patients volume. Herein, we have reviewed our 5-year experience of adoption and evolution of this surgical technique, examining the donor and recipient outcomes.
Between September 2002 and June 2007, 40 LDNs were performed consecutively. Our surgical technique was mainly derived from the University of California San Francisco method. We retrospectively reviewed the donor demographics, operative characteristics, perioperative complication of donors/recipients, and outcomes of donors and recipients.
Among the 40 cases, 36 (90.0%) were left-sided LDNs. Mean operative time was 335.1 +/- 66.9 minutes, blood loss was 303.9 +/- 333.2 mL, and warm ischemia time was 243.2 +/- 127.0 seconds. Multiple renal arteries required bench arterial reconstruction in 7 (17.5%) donor kidneys. Three renovascular injuries occurred intraoperatively, and 2 (5.0%) required open conversion. The overall postoperative complication rate was 20.0%. Postoperative donor serum creatinine was 1.5 times higher than preoperative serum creatinine. All but one recipient was discharged with adequate renal function. Graft function continues in 36 of the 38 harvested kidneys (94.7%) during the follow-up period. One (2.5%) recipient developed ureteral necrosis, and no recipients developed vascular thrombosis.
LDNs can be performed with careful adoption and evolution in institutions without a large patient volume. The intraoperative complication rate of LDN can be reduced with experience.
尽管腹腔镜活体供肾切除术（LDN）具有诸多优势，但该技术存在陡峭的学习曲线，这使得其在全球范围内的推广面临挑战，尤其是在患者数量不多的机构。在此，我们回顾了我们在采用和发展这种手术技术方面的5年经验，研究了供体和受体的结局。
2002年9月至2007年6月期间，连续进行了40例LDN手术。我们的手术技术主要源自加利福尼亚大学旧金山分校的方法。我们回顾性分析了供体的人口统计学资料、手术特征、供体/受体的围手术期并发症以及供体和受体的结局。
在40例病例中，36例（90.0%）为左侧LDN。平均手术时间为335.1±66.9分钟，失血量为303.9±333.2毫升，热缺血时间为243.2±127.0秒。7例（17.5%）供肾需要在手术台上进行动脉重建。术中发生了3例肾血管损伤，2例（5.0%）需要转为开放手术。总体术后并发症发生率为20.0%。术后供体血清肌酐比术前血清肌酐高1.5倍。除1例受体外，所有受体均在肾功能良好的情况下出院。在随访期间，38个切取的肾脏中有36个（94.7%）移植肾功能持续良好。1例（2.5%）受体发生输尿管坏死，无受体发生血管血栓形成。
在患者数量不多的机构中，谨慎采用和发展LDN手术是可行的。随着经验的积累，LDN的术中并发症发生率可以降低。
