He Bulang, Mitchell Andrew, Delriviere Luc, Shannon Tom, Pemberton Richard, Tan Andrew, Bremner Alexandra, Vivian Justin
Western Australia Liver and Kidney Transplant Service, Sir Charles Gairdner Hospital, Nedlands, 6009, Australia.
ANZ J Surg. 2011 Mar;81(3):159-63. doi: 10.1111/j.1445-2197.2010.05568.x. Epub 2010 Nov 17.
Kidney transplantation is a definitive treatment of end-stage renal disease. Laparoscopic donor nephrectomy (LDN) has been widely accepted around the world since its introduction in 1995 as a minimum invasive procedure. We report our clinical experience of 141 consecutive LDNs performed in two tertiary hospitals in Western Australia.
From December 2000 (Royal Perth Hospital) and January 2005 (Sir Charles Gairdner Hospital) to January 2009, 141 LDNs were performed in two tertiary hospitals by four urologists. All donors underwent rigorous work-up prior to surgery. Donor age ranged from 23 years to 81 years (49.85 ± 11.30 years). The male to female ratio was 1 to 1.3. Donor body mass index (BMI) was 26.77 ± 4.31, and glomerular filtration rate was 96.25 ± 12.33 mL/min/1.73 sqm. The laparoscopic technique was transperitoneal approach exclusively.
All LDNs were performed successfully without hand assistance. The warm ischaemic time ranged from 3 to 11 min. The hospital stay was 4.16 ± 1.30 days. The overall complication rate was 17.0%, with three major complications (2.1%): a splenetic infarction, a chylous ascites and a pulmonary embolism occurred. Donors' demographic data (age, sex, BMI, side of surgery) did not show a statistically significant association with surgical complications.
Transperitoneal laparoscopic live donor nephrectomy is a safe and effective procedure. Combined use of vascular stapler and Hem-o-Lok is very important for management of the renal artery stump. It is our current practice to administer anticoagulants during and post-surgery for at least 2 weeks.
肾移植是终末期肾病的确定性治疗方法。自1995年腹腔镜供肾切除术（LDN）作为一种微创手术被引入以来，已在全球范围内广泛接受。我们报告了在西澳大利亚的两家三级医院连续进行的141例LDN的临床经验。
从2000年12月（皇家珀斯医院）和2005年1月（查尔斯·盖尔德纳爵士医院）至2009年1月，由四位泌尿科医生在两家三级医院进行了141例LDN。所有供体在手术前均接受了严格的检查。供体年龄从23岁至81岁（49.85±11.30岁）。男女比例为1比1.3。供体体重指数（BMI）为26.77±4.31，肾小球滤过率为96.25±12.33 mL/min/1.73平方米。腹腔镜技术均采用经腹途径。
所有LDN均成功完成，无需手辅助。热缺血时间为3至11分钟。住院时间为4.16±1.30天。总体并发症发生率为17.0%，发生了3例严重并发症（2.1%）：脾梗死、乳糜腹水和肺栓塞。供体的人口统计学数据（年龄、性别、BMI、手术侧）与手术并发症无统计学显著关联。
经腹腹腔镜活体供肾切除术是一种安全有效的手术。血管吻合器和Hem-o-Lok的联合使用对肾动脉残端的处理非常重要。我们目前的做法是在手术期间和术后至少使用抗凝剂2周。
