Department of Urology, Indiana University Medical Center, Indianapolis, Indiana 46202-5289, USA.
J Urol. 2010 Nov;184(5):2054-9. doi: 10.1016/j.juro.2010.06.150. Epub 2010 Sep 18.
In patients with autosomal dominant polycystic kidney disease we compared the outcome of bilateral laparoscopic nephrectomy at a single operation vs staged nephrectomy, including 1 during transplantation and the other via laparoscopic unilateral nephrectomy.
We reviewed the records of patients with autosomal dominant polycystic kidney disease requiring renal transplantation and native bilateral nephrectomy. We compared transplantation with ipsilateral nephrectomy to transplantation alone and then compared unilateral to bilateral laparoscopic native nephrectomy. Indications included pain, infection, bleeding and compressive symptoms.
We followed 42 patients, including 16 with transplantation and nephrectomy, 22 with transplantation alone and 4 awaiting transplantation. In those with transplantation vs transplantation with nephrectomy there were no differences in median age (48.3 vs 53.3 years, p = 0.178) or greatest kidney length (19.5 vs 20.9 cm, p = 0.262). Operative time (208 vs 236 minutes, p = 0.104), estimated blood loss (200 vs 250 ml, p = 0.625), hospital discharge creatinine (1.60 vs 1.50 mg/dl, p = 0.491) and complications were similar. We separately compared 24 bilateral and 18 unilateral laparoscopic native nephrectomies, and noted similarities in median age (52.0 vs 56.3 years, p = 0.281) and kidney length (19.5 vs 19.8 cm, p = 0.752). Bilateral nephrectomy showed greater estimated blood loss (125 vs 50 ml, p = 0.001) and operative time (302.8 vs 170.2 minutes, p <0.001). There were 4 open conversions, 9 perioperative complications at bilateral surgery and 1 complication after unilateral surgery. Median followup in the unilateral and bilateral groups was 13.3 vs 35.9 months (p = 0.015).
Renal transplantation and ipsilateral native nephrectomy carry no significant additional morbidity compared to that of renal transplantation alone. Staged unilateral laparoscopic nephrectomy was superior to the bilateral procedure in perioperative outcome.
在常染色体显性遗传性多囊肾病患者中，我们比较了单次手术中双侧腹腔镜肾切除术与分期肾切除术的结果，其中包括 1 例在移植术中进行，另 1 例通过腹腔镜单侧肾切除术进行。
我们回顾了需要肾移植和双侧自体肾切除术的常染色体显性遗传性多囊肾病患者的病历。我们将同侧肾切除术与单纯移植术进行了比较，然后将单侧手术与双侧腹腔镜自体肾切除术进行了比较。手术指征包括疼痛、感染、出血和压迫症状。
我们随访了 42 例患者，其中 16 例接受了移植和肾切除术，22 例仅接受了移植术，4 例等待移植。在接受移植和肾切除术的患者中，中位年龄（48.3 岁 vs 53.3 岁，p = 0.178）或最大肾脏长度（19.5 厘米 vs 20.9 厘米，p = 0.262）无差异。手术时间（208 分钟 vs 236 分钟，p = 0.104）、估计失血量（200 毫升 vs 250 毫升，p = 0.625）、出院时血肌酐（1.60 毫克/分升 vs 1.50 毫克/分升，p = 0.491）和并发症相似。我们分别比较了 24 例双侧腹腔镜和 18 例单侧腹腔镜自体肾切除术，发现中位年龄（52.0 岁 vs 56.3 岁，p = 0.281）和肾脏长度（19.5 厘米 vs 19.8 厘米，p = 0.752）相似。双侧肾切除术的估计失血量（125 毫升 vs 50 毫升，p = 0.001）和手术时间（302.8 分钟 vs 170.2 分钟，p <0.001）均较大。有 4 例转为开放性手术，双侧手术中有 9 例围手术期并发症，单侧手术后有 1 例并发症。单侧组和双侧组的中位随访时间分别为 13.3 个月和 35.9 个月（p = 0.015）。
与单纯移植术相比，肾移植和同侧自体肾切除术并无显著增加的并发症。分期单侧腹腔镜肾切除术在围手术期结果方面优于双侧手术。
