Vavallo A, Lucarelli G, Bettocchi C, Tedeschi M, Palazzo S, Losappio V, Gesualdo L, Grandaliano G, Selvaggi F P, Battaglia M, Ditonno P
Urology, Andrology, and Kidney Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy.
Transplant Proc. 2012 Sep;44(7):1922-5. doi: 10.1016/j.transproceed.2012.06.011.
The objective of this study was to evaluate differences in outcomes of allograft nephrectomies performed by extracapsular versus intracapsular techniques.
From 1993 to 2010, we performed 89 allograft nephrectomies, including 57 by extracapsular techniques and 32 by intracapsular, chosen according to feasibility at the beginning of the surgery. Fisher exact test and logistic regression were used for statistical analysis. Survival estimates after allograft nephrectomy were calculated according to the Kaplan-Meier method.
After a mean graft survival of 49.7 months, the indications for transplant nephrectomy were chronic rejection (39.3%), acute rejection (22.5%), infection/sepsis (19.1%), gross hematuria (6.7%), renal vein thrombosis (6.7%), renal artery thrombosis (3.4%), and graft rupture (2.3%). Mean operative time, blood loss, transfusions, and complications were similar between the extracapsular and intracapsular groups. The only difference in surgical aspects between the 2 groups was the mean hospital stay, which was longer for the extracapsular group (13.8 vs 7.6 days; P = .01), a result that was confirmed by multivariate analysis (odds ratio, 1.05; 95% confidence interval, 1.0-1.1; P = .03).
Our experience showed no significant advantages in favor of the intracapsular technique except for a shorter length of hospital stay than after the extracapsular procedure.
本研究的目的是评估采用囊外与囊内技术进行同种异体肾切除术的结果差异。
1993年至2010年，我们共进行了89例同种异体肾切除术，其中57例采用囊外技术，32例采用囊内技术，手术开始时根据可行性进行选择。采用Fisher精确检验和逻辑回归进行统计分析。根据Kaplan-Meier方法计算同种异体肾切除术后的生存估计值。
移植肾平均存活49.7个月后，移植肾切除术的指征为慢性排斥反应（39.3%）、急性排斥反应（22.5%）、感染/脓毒症（19.1%）、肉眼血尿（6.7%）、肾静脉血栓形成（6.7%）、肾动脉血栓形成（3.4%）和移植肾破裂（2.3%）。囊外组和囊内组的平均手术时间、失血量、输血情况和并发症相似。两组手术方面的唯一差异是平均住院时间，囊外组更长（13.8天对7.6天；P = 0.01），多因素分析证实了这一结果（优势比，1.05；95%置信区间，1.0 - 1.1；P = 0.03）。
我们的经验表明，除住院时间比囊外手术短外，囊内技术没有明显优势。
