Hakim N, Aboutaleb E, Syed A, Rajagopal P, Herbert P, Canelo R, Papalois V
The West London Renal and Transplant Centre, Imperial College Healthcare NHS Trust, London, UK.
Transplant Proc. 2010 Jan-Feb;42(1):165-70. doi: 10.1016/j.transproceed.2009.12.042.
To determine operative parameters and complications, using a modified approach to mini-incision living donor nephrectomy.
Three hundred fifty-nine consecutive living donor procedures were performed between October 2000 and November 2008 using the finger-assisted, mini-incision living donor nephrectomy. Patient demographics, intraoperative parameters, and postoperative complications were prospectively recorded, including operative time, blood loss, incision length, warm ischemia time, and intraoperative adverse events.
Mean donor age was 44.2 +/- 12.3 years (range, 21-75 years), with an average body mass index of 28.2 +/- 5.3 kg/m(2) (range, 17.1-44.9 kg/m(2)). Right-sided donor nephrectomies were performed on 23 patients (6%), and 41 donors (11%) were found to have multiple renal arteries. Median incision length was 6.8 cm (range, 3.5-15 cm). Average operative time was 117 minutes (range, 50-265 minutes), with a median blood loss of 109 mL (range, 20-500 mL) and an average warm ischemia time of 4.5 minutes (range, 1.5-10 minutes). Four patients (1%) required perioperative blood transfusions. There were no other intraoperative complications, no patients required reexploration, and there were no donor deaths. Thirteen patients (4%) developed minor postoperative complications, including two incisional herniae, but no patients developed chronic wound pain, over a median follow-up period of 19 months (range, 2-97 months).
This prospective series demonstrated that a modified approach to open mini-incision nephrectomy can result in a smaller incision length while maintaining patient safety, with few postoperative complications.
采用改良的小切口活体供肾肾切除术方法，确定手术参数及并发症情况。
2000年10月至2008年11月期间，连续进行了359例活体供肾手术，采用手指辅助小切口活体供肾肾切除术。前瞻性记录患者人口统计学资料、术中参数及术后并发症，包括手术时间、失血量、切口长度、热缺血时间及术中不良事件。
供者平均年龄为44.2±12.3岁（范围21 - 75岁），平均体重指数为28.2±5.3kg/m²（范围17.1 - 44.9kg/m²）。23例患者（6%）进行了右侧供肾肾切除术，41例供者（11%）发现有多支肾动脉。中位切口长度为6.8cm（范围3.5 - 15cm）。平均手术时间为117分钟（范围50 - 265分钟），中位失血量为109ml（范围20 - 500ml），平均热缺血时间为4.5分钟（范围1.5 - 10分钟）。4例患者（1%）需要围手术期输血。无其他术中并发症，无需再次手术探查，无供者死亡。13例患者（4%）出现轻微术后并发症，包括2例切口疝，但无患者出现慢性伤口疼痛，中位随访期为19个月（范围2 - 97个月）。
该前瞻性系列研究表明，改良的开放性小切口肾切除术可在保持患者安全的同时缩短切口长度，术后并发症较少。
