Taweemonkongsap T, Nualyong C, Amornvesukit T, Srinualnad S, Jitpraphai S, Premasathian N, Sujijantararat P, Tantiwong A, Soontrapa S
Division of Urology, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Transplant Proc. 2011 Dec;43(10):3593-8. doi: 10.1016/j.transproceed.2011.08.115.
We report our experience with laparoscopic donor nephrectomy (LDN) compared with open donor nephrectomy (ODN). Prognostic factors associated with adverse outcomes in LDN were identified.
From January 2000 to December 2009, 243 consecutive live-donor nephrectomies were performed, including 129 LDNs and 114 ODNs. We compared patient demographics, perioperative outcomes, and recipient graft function in each group. Prognostic factors for adverse outcomes in LDN were investigated using uni- and multivariate analyses.
Patient demographics, except mean donor age (P=.032), were similar between groups. Mean operative time (219 vs 163 minutes; P<.001) and warm ischemia time (WIT; 3.1 vs 1.7 minutes; P<.001) were significantly longer in LDN. Conversely, mean analgesic requirement (9.2 vs 14.7 mg morphine; P<.001) and postoperative hospital stay (6.5 vs 7.1 days; P=.003) were significantly lower with LDN. Mean estimated blood loss (EBL) was slightly lower in LDN (P=.15). There were 7 conversions from LDN to ODN. Complication rates were similar between the groups (P=.38). Delayed graft function (10.9% vs 1.7%; P=.016) and mean serum creatinine level at 1 month (1.47 vs 1.3 mg/dL; P=.04) were higher for LDN. However, 5-year allograft survival was not inferior among LDN (90% vs 85%; P=.42). Mean operative time (268 to 175 minutes; P<.001), EBL (316 to 66 mL; P<.001), and complication incidence (8 to 0 cases; P<.002) gradually decreased from the initial 43 cases to the last 43 cases of LDNs. Among surgeons who had performed-30 LDNs, the mean operative time and WIT were 197 mL and 2.8 minutes, respectively.
Based on our evidence, LDN was a feasible and safe surgical option for live-donor nephrectomy, even in a small volume center. Better results can be achieved after a learning curve of experience for both the surgeon and the institution.
我们报告了腹腔镜供肾切除术（LDN）与开放性供肾切除术（ODN）的经验。确定了与LDN不良结局相关的预后因素。
2000年1月至2009年12月，连续进行了243例活体供肾切除术，其中包括129例LDN和114例ODN。我们比较了每组患者的人口统计学、围手术期结局和受者移植肾功能。使用单因素和多因素分析研究LDN不良结局的预后因素。
除平均供者年龄外（P = 0.032），两组患者的人口统计学特征相似。LDN的平均手术时间（219对163分钟；P < 0.001）和热缺血时间（WIT；3.1对1.7分钟；P < 0.001）明显更长。相反，LDN的平均镇痛需求量（9.2对14.7毫克吗啡；P < 0.001）和术后住院时间（6.5对7.1天；P = 0.003）明显更低。LDN的平均估计失血量（EBL）略低（P = 0.15）。有7例从LDN转为ODN。两组的并发症发生率相似（P = 0.38）。LDN的移植肾功能延迟发生率（10.9%对1.7%；P = 0.016）和1个月时的平均血清肌酐水平（1.47对1.3毫克/分升；P = 0.04）更高。然而，LDN的5年移植肾存活率并不低（90%对85%；P = 0.42）。从LDN的最初43例到最后43例，平均手术时间（268至175分钟；P < 0.001）、EBL（316至66毫升；P < 0.001）和并发症发生率（8至0例；P < 0.002）逐渐降低。在进行了30例以上LDN的外科医生中，平均手术时间和WIT分别为197分钟和2.8分钟。
根据我们的证据，LDN是活体供肾切除术的一种可行且安全的手术选择，即使在小容量中心也是如此。外科医生和机构经过经验学习曲线后可取得更好的结果。
