Ferrario M, Buckel E, Astorga C, Godoy J, Aguiló J, González G, Ormazábal J, Cámbara A, Derosas C, Herzog C, Calabrán L
Unit of Transplantation, Clínica las Condes, Santiago, Chile.
Transplant Proc. 2013;45(10):3716-8. doi: 10.1016/j.transproceed.2013.08.089.
Renal transplantation is the most successful therapy to improve survival and quality of life for patients with end-stage renal disease. Living donors have been used as an alternative to reduce the stay on the waiting list. Laparoscopic living donor nephrectomy has become the standard procedure for renal transplantation. Minimally invasive surgery involves less postoperative pain with less analgesic requirements allowing shorter hospital stay for the donor.
We retrospectively analyzed demographic and intraoperative data and surgical complications for 46 patients who underwent laparoscopic living donor nephrectomy between March 2001 and March 2011.
Mean donor age was 41 years. Mean operative time was 170 ± 45 minutes. The average cold ischemic time was 40 minutes and warm ischemic time was 26 minutes. Twenty-one patients were donors for pediatric receptors. Fourty patients underwent left laparoscopic nephrectomy, the other 6 patients underwent right laparoscopic nephrectomy due to vascular anatomic variant. Right laparoscopic nephrectomy was converted in 1 case (2.2%) due to renal vein laceration without donor morbidity and without compromise of graft function. Renal function at the second day post donor nephrectomy was measured using serum creatinine averaged 1.2 mg/dL with a mean increase of 0.4 mg/dL from baseline, with normalization after 30 days. No patient required blood transfusion, and there were no immediate surgical complications, infections, or mortality. One patient developed an incisional hernia in relation to the site of kidney removal. The mean hospital stay was 5 ± 1 days.
Laparoscopic nephrectomy in our experience is a safe technique without postoperative morbidity or mortality. It is associated with low levels of pain, early discharge and early return to physical activity and work, good sense of aesthetic results, and long-term graft function comparable to traditional nephrectomy and cadaveric grafts.
肾移植是改善终末期肾病患者生存率和生活质量最成功的治疗方法。活体供肾已被用作减少等待名单上停留时间的替代方案。腹腔镜活体供肾切除术已成为肾移植的标准术式。微创手术术后疼痛较轻，镇痛需求较少，供体住院时间较短。
我们回顾性分析了2001年3月至2011年3月期间接受腹腔镜活体供肾切除术的46例患者的人口统计学和术中数据以及手术并发症。
供体平均年龄为41岁。平均手术时间为170±45分钟。平均冷缺血时间为40分钟，热缺血时间为26分钟。21例患者为儿童受体供体。40例患者接受左腹腔镜肾切除术，另外6例患者因血管解剖变异接受右腹腔镜肾切除术。1例（2.2%）右腹腔镜肾切除术因肾静脉撕裂而中转，供体无并发症，移植肾功能未受影响。供肾切除术后第二天使用血清肌酐测量肾功能，平均为1.2mg/dL，较基线平均升高0.4mg/dL，30天后恢复正常。无患者需要输血，无即刻手术并发症、感染或死亡。1例患者在肾切除部位出现切口疝。平均住院时间为5±1天。
根据我们的经验，腹腔镜肾切除术是一种安全的技术，无术后并发症或死亡。它与疼痛程度低、早期出院、早期恢复体力活动和工作、美学效果良好以及长期移植肾功能与传统肾切除术和尸体肾移植相当有关。
