Eng Mary, Jones Christopher M, Cannon Robert M, Marvin Michael R
Department of Surgery, University of Louisville, Louisville, KY, USA.
JSLS. 2013 Apr-Jun;17(2):279-84. doi: 10.4293/108680813X13654754535719.
Historically, nephrectomy for autosomal dominant polycystic kidney disease was performed by an open technique. We performed this study to compare outcomes in hand-assisted laparoscopic nephrectomy with open nephrectomy in this population.
Charts of patients with autosomal dominant polycystic kidney disease who underwent nephrectomy by a transplant surgeon from January 1, 2000, to December 31, 2011, were reviewed. The hand-assisted laparoscopic nephrectomy group was compared with the open group. Data collected included unilateral versus bilateral nephrectomy, operative time, complications, transfusion requirement, and length of stay.
Of the 78 patients identified, 18 underwent open transabdominal nephrectomy, 56 underwent hand-assisted laparoscopic nephrectomy, and 2 underwent hand-assisted laparoscopic nephrectomy that was converted to an open procedure. Two patients were excluded because another major procedure was performed at the same time as the nephrectomy. Operative times were similar. Patients undergoing open bilateral nephrectomy were more likely to receive transfusion (odds ratio, 3.57 [95% confidence interval, 0.74-17.19]; P = .016), and the length of stay was longer in the open groups (5.9 days vs 4.0 days for unilateral [P = .013] and 7.8 days vs 4.6 days for bilateral [P = .001]). Overall complication rates were similar. The most frequent complications associated with hand-assisted laparoscopic nephrectomy were the development of an incisional hernia at the hand-port site and arteriovenous fistula thrombosis.
Hand-assisted laparoscopic nephrectomy can be safely performed without increased operative times or complications. The hand-assisted laparoscopic nephrectomy group enjoyed a shorter length of stay, and fewer patients in this group received transfusion. For patients considering renal transplantation, avoidance of transfusion is important to prevent sensitization and limiting access to compatible organs.
从历史上看，常染色体显性遗传性多囊肾病的肾切除术采用开放技术进行。我们开展这项研究以比较该人群中手辅助腹腔镜肾切除术与开放肾切除术的疗效。
回顾了2000年1月1日至2011年12月31日期间由一位移植外科医生为常染色体显性遗传性多囊肾病患者施行肾切除术的病历。将手辅助腹腔镜肾切除术组与开放手术组进行比较。收集的数据包括单侧与双侧肾切除术、手术时间、并发症、输血需求及住院时间。
在确定的78例患者中，18例行开放经腹肾切除术，56例行手辅助腹腔镜肾切除术，2例行手辅助腹腔镜肾切除术中转开放手术。2例患者被排除，因为在肾切除术同时还进行了另一项大型手术。手术时间相似。接受开放双侧肾切除术的患者更可能接受输血（优势比，3.57[95%可信区间，0.74 - 17.19]；P = 0.016），开放手术组的住院时间更长（单侧手术开放组为5.9天，手辅助腹腔镜肾切除术组为4.0天[P = 0.013]；双侧手术开放组为7.8天，手辅助腹腔镜肾切除术组为4.6天[P = 0.001]）。总体并发症发生率相似。与手辅助腹腔镜肾切除术相关的最常见并发症是手辅助端口部位切口疝形成及动静脉瘘血栓形成。
手辅助腹腔镜肾切除术可安全实施，且不增加手术时间或并发症。手辅助腹腔镜肾切除术组住院时间较短，该组接受输血的患者较少。对于考虑肾移植的患者，避免输血对于防止致敏及限制获得匹配器官的机会很重要。
