腹腔镜与开放性供体肾切除术的随机临床试验。

Randomized clinical trial of laparoscopic versus open donor nephrectomy.

作者信息

Nicholson M L, Kaushik M, Lewis G R R, Brook N R, Bagul A, Kay M D, Harper S J, Elwell R, Veitch P S

机构信息

Transplant Surgery Group, Department of Infection, Immunity and Inflammation, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK.

出版信息

Br J Surg. 2010 Jan;97(1):21-8. doi: 10.1002/bjs.6803.

DOI:10.1002/bjs.6803

PMID:19937983

Abstract

BACKGROUND

This randomized controlled trial was designed to determine the safety and efficacy of laparoscopic donor nephrectomy (LDN) in comparison with short-incision open donor nephrectomy (ODN).

METHODS

Eighty-four live kidney donors were randomized in a 2 : 1 ratio to LDN (56 patients) or short-incision ODN without rib resection (28). Primary endpoints were pain relief and duration of inpatient stay.

RESULTS

There was no donor death or allograft thrombosis in either group. The first warm ischaemic time median (range) 4 (2-7) versus 2 (1-5) min; P = 0.001) and the duration of operation (160 (110-250) versus 150 (90-200); P = 0.004) were longer for LDN. LDN led to a reduction in parenteral morphine requirement 59 (6-136) versus 90 (35-312) mg; P = 0.001) and hospital stay (4 (2-6) versus 6 (2-9) days; P = 0.001), and earlier return to employment (42 (14-84) versus 66.5 (14-112) days; P = 0.004). Postoperative respiratory function was improved after LDN. There were more postoperative complications per donor in the ODN group (0.6(0.7) versus 0.3(0.5); P = 0.033). At a median follow-up of 74 months, there were no differences in renal function or allograft survival between the groups.

CONCLUSION

LDN removes some of the disincentives to live donation without compromising the outcome of the recipient transplant.

摘要

背景

本随机对照试验旨在确定腹腔镜供肾切除术（LDN）与小切口开放性供肾切除术（ODN）相比的安全性和有效性。

方法

84名活体肾供者按2:1的比例随机分为LDN组（56例患者）或不切除肋骨的小切口ODN组（28例）。主要终点是疼痛缓解情况和住院时间。

结果

两组均未发生供者死亡或移植肾血栓形成。LDN组的首次热缺血时间中位数（范围）为4（2 - 7）分钟，而ODN组为2（1 - 5）分钟；P = 0.001），且手术时间更长（160（110 - 250）分钟对150（90 - 200）分钟；P = 0.004）。LDN组减少了胃肠外吗啡用量（59（6 - 136）毫克对90（35 - 312）毫克；P = 0.001）和住院时间（4（2 - 6）天对6（2 - 9）天；P = 0.001），并更早恢复工作（42（14 - 84）天对66.5（14 - 112）天；P = 0.004）。LDN术后呼吸功能得到改善。ODN组每个供者的术后并发症更多（0.6（0.7）对0.3（0.5）；P = 0.033）。在中位随访74个月时，两组间肾功能或移植肾存活率无差异。