Dolce Charles J, Keller Jennifer E, Walters K Christian, Griffin Daniel, Norton H James, Heniford B Todd, Kercher Kent W
Department of Surgery, Division of Gastrointestinal and Minimally Invasive Surgery, Carolinas Medical Center, Charlotte, NC, USA.
Surg Endosc. 2009 Jul;23(7):1564-8. doi: 10.1007/s00464-009-0340-7. Epub 2009 Mar 5.
Minimally invasive surgical techniques have become the preferred method for live donor nephrectomy (DN) in many centers. We compared our experience with laparoscopic and open DN in a single institution.
Data for 266 consecutive live DNs were collected. Demographic, intraoperative, and postoperative data were compared.
A total of 199 hand-assisted laparoscopic (HAL) DNs, 18 totally laparoscopic (TL), and 49 open DNs were performed. Laparoscopic DN was associated with a shorter operative time (p < 0.013), less blood loss (p < 0.0001), and shorter hospital stay (p < 0.0001) than open DN. Warm ischemia time was less for HAL versus TL DN (59.9 vs. 90.0 seconds; p < 0.0001). Compared with open DN, laparoscopic patients had fewer complications (p < 0.03), fewer wound infections (p < 0.004), less wound paresthesias (p < 0.0009), and fewer complaints of chronic incisional pain (p < 0.0001). Delayed graft function during the first 24 h postoperatively was significantly less for the laparoscopic DN versus the open cases (12.9% vs. 30.4%; p = 0.003), but the need for hemodialysis for the recipient was similar between groups (6.9% vs. 5%; p = not significant).
Laparoscopic DN resulted in less blood loss, reduced operative time, and shorter hospital stay than open DN. Hand-assisted laparoscopic DN has the potential to decrease warm ischemia time for renal allografts. Donors managed laparoscopically had fewer complications, significantly less wound-related morbidity, and less delayed graft function than patients who underwent open DN.
在许多中心，微创外科技术已成为活体供肾肾切除术（DN）的首选方法。我们在单一机构中比较了腹腔镜和开放DN的经验。
收集了连续266例活体DN的数据。比较了人口统计学、术中及术后数据。
共进行了199例手辅助腹腔镜（HAL）DN、18例全腹腔镜（TL）DN和49例开放DN。与开放DN相比，腹腔镜DN的手术时间更短（p < 0.013）、失血量更少（p < 0.0001）、住院时间更短（p < 0.0001）。HAL DN的热缺血时间比TL DN短（59.9秒对90.0秒；p < 0.0001）。与开放DN相比，腹腔镜手术患者的并发症更少（p < 0.03）、伤口感染更少（p < 0.004）、伤口感觉异常更少（p < 0.0009）、慢性切口疼痛主诉更少（p < 0.0001）。术后24小时内腹腔镜DN的移植肾功能延迟明显少于开放手术病例（12.9%对30.4%；p = 0.003），但两组间受者对血液透析的需求相似（6.9%对5%；p = 无显著性差异）。
与开放DN相比，腹腔镜DN导致的失血量更少、手术时间缩短且住院时间更短。手辅助腹腔镜DN有可能减少肾移植的热缺血时间。与接受开放DN的患者相比，腹腔镜处理的供者并发症更少、与伤口相关的发病率显著更低且移植肾功能延迟更少。
