Touma Naji J, Sener Alp, Caumartin Yves, Warren Jeff, Nguan Christopher Y, Luke Patrick P W
Division of Urology, University of Western Ontario, London, ON.
Can Urol Assoc J. 2011 Feb;5(1):49-52. doi: 10.5489/cuaj.10016.
Our objective was to compare the impact of extra-capsular (ECAN) versus intracapsular allograft nephrectomy (ICAN) on allosensitization and surgical outcomes.
Between 1990 and 2004, 96 allograft nephrectomies were performed at our institution. Of these, 29 procedures were performed within 1 month of the transplant and were therefore omitted from analysis. Overall, the results of 44 ECAN and 23 ICAN were reviewed.
The mean operative times were 110.9 versus 130.4 min for ICAN versus ECAN (p = 0.02) and the estimated blood loss was 226 mL for ICAN versus 483 mL for ECAN (p = 0.004). Intraoperative and postoperative complications were low using either technique and differences were not statistically significant. Overall, the preoperative to postoperative change in the percentage of panel reactive antibody was +2.1% for ICAN versus +1.2% for ECAN (NS) at 3 to 12 months postoperatively, respectively (NS). The percentage of patients relisted was 33.3% versus 54.3% (NS), and the percentage of patients re-transplanted once relisted was also very similar: 63.2% for ECAN versus 66.7% for ICAN (NS), after a mean follow-up of 4.5 and 8.4 years, respectively.
ICAN can be performed with shorter operative times and less blood loss versus the extracapsular approach. As well, this operative approach does not appear to affect allosensitization and the ability to re-transplant patients.
我们的目的是比较囊外同种异体肾切除术（ECAN）与囊内同种异体肾切除术（ICAN）对致敏作用和手术结果的影响。
1990年至2004年间，我们机构共进行了96例同种异体肾切除术。其中，29例手术在移植后1个月内进行，因此被排除在分析之外。总体而言，回顾了44例ECAN和23例ICAN的结果。
ICAN与ECAN的平均手术时间分别为130.4分钟和110.9分钟（p = 0.02），ICAN的估计失血量为226毫升，而ECAN为483毫升（p = 0.004）。两种技术的术中和术后并发症发生率都很低，差异无统计学意义。总体而言，术后3至12个月，ICAN的群体反应性抗体百分比术前至术后变化为+2.1%，而ECAN为+1.2%（无显著性差异）。再次列入移植名单的患者百分比分别为33.3%和54.3%（无显著性差异），再次列入名单后再次移植的患者百分比也非常相似：ECAN为63.2%，ICAN为66.7%（无显著性差异），平均随访时间分别为4.5年和8.4年。
与囊外手术方法相比，ICAN手术时间更短，失血量更少。此外，这种手术方法似乎不会影响致敏作用和患者再次移植的能力。
