随机对照试验比较手助腹膜后腹腔镜与标准腹腔镜供肾切取术。

Randomized controlled trial comparing hand-assisted retroperitoneoscopic versus standard laparoscopic donor nephrectomy.

机构信息

1 Department of Surgery, Division of Transplant Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands. 2 Department of Urology, Radboud University Nijmegen Medical Center, The Netherlands. 3 Department of Internal Medicine, Division of Nephrology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands. 4 Department of Nephrology, Radboud University Nijmegen Medical Center, The Netherlands. 5 Address correspondence to: Jan N.M. IJzermans, M.D., Ph.D., Department of Surgery, Division of Transplant Surgery, Erasmus MC, University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.

出版信息

Transplantation. 2014 Jan 27;97(2):161-7. doi: 10.1097/TP.0b013e3182a902bd.

DOI:10.1097/TP.0b013e3182a902bd

PMID:24092379

Abstract

BACKGROUND

Laparoscopic donor nephrectomy (LDN) has become the gold standard for live-donor nephrectomy, as it results in a short convalescence time and increased quality of life. However, intraoperative safety has been debated, as severe complications occur incidentally. Hand-assisted retroperitoneoscopic donor nephrectomy (HARP) is an alternative approach, combining the safety of hand-guided surgery with the benefits of endoscopic techniques and retroperitoneal access. We assessed the best approach to optimize donors' quality of life and safety.

METHODS

In two tertiary referral centers, donors undergoing left-sided nephrectomy were randomly assigned to HARP or LDN. Primary endpoint was physical function, one of the dimensions of the Short Form-36 questionnaire on quality of life, at 1 month postoperatively. Secondary endpoints included intraoperative events and operation times. Follow-up was 1 year.

RESULTS

In total, 190 donors were randomized. Physical function at 1 month follow-up did not significantly differ between groups (estimated difference, 1.79; 95% confidence interval, -4.1 to 7.68; P=0.55). HARP resulted in significantly shorter skin-to-skin time (mean, 159 vs. 188 min; P<0.001), shorter warm ischemia time (2 vs. 5 min; P<0.001) and a lower intraoperative event rate (5% vs. 11%, P=0.117). Length of stay (both 3 days; P=0.135) and postoperative complication rate (8% vs. 8%; P=1.00) were not significantly different. Potential graft-related complications did not significantly differ (6% vs. 13%; P=0.137).

CONCLUSIONS

Compared with LDN, left-sided HARP leads to similar quality of life, shorter operating time, and warm ischemia time. Therefore, we recommend HARP as a valuable alternative to the laparoscopic approach for left-sided donor nephrectomy.

摘要

背景

腹腔镜供体肾切除术（LDN）已成为活体供肾切除术的金标准，因为它可以缩短恢复期并提高生活质量。然而，术中安全性存在争议，因为意外会发生严重并发症。手助经腹膜后腹腔镜供体肾切除术（HARP）是一种替代方法，它将手引导手术的安全性与内窥镜技术和腹膜后入路的优势相结合。我们评估了优化供体生活质量和安全性的最佳方法。

方法

在两个三级转诊中心，接受左侧肾切除术的供体被随机分配接受 HARP 或 LDN。主要终点是术后 1 个月的生活质量短表-36 问卷的身体功能维度。次要终点包括术中事件和手术时间。随访时间为 1 年。

结果

共有 190 名供体被随机分配。术后 1 个月时，两组之间的身体功能没有显著差异（估计差异，1.79；95%置信区间，-4.1 至 7.68；P=0.55）。HARP 导致皮肤到皮肤的时间明显缩短（平均，159 对 188 分钟；P<0.001），热缺血时间缩短（2 对 5 分钟；P<0.001），术中事件发生率降低（5%对 11%，P=0.117）。住院时间（均为 3 天；P=0.135）和术后并发症发生率（8%对 8%；P=1.00）无显著差异。潜在的移植物相关并发症也无显著差异（6%对 13%；P=0.137）。