迷你腹腔镜与标准腹腔镜供肾切除术：一项随机临床试验中的安全性、有效性及美容效果比较

Simforoosh Nasser, Hosseini Sharifi Seyed Hossein, Valipour Reza, Narouie Behzad, Kamranmanesh Mohammad Reza, Soltani Mohammad Hossein

Shahid Labbafinejad Medical Center, Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Shahid Labbafinejad Medical Center, Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran..

Urol J. 2015 Sep 4;12(4):2223-7.

PURPOSE

This study was conducted to compare safety, efficacy and cosmetic outcome between standard laparoscopic live donor nephrectomy (sLDN) and mini-laparoscopic donor nephrectomy (mLDN) in a randomized clinical trial.

MATERIALS AND METHODS

From March 2012 to June 2013, 100 consecutive kidney donors were randomly assigned to two equal groups for laparoscopic donor nephrectomy. mLDN: Six to eight centimeters Pfannenstiel incision was made slightly above pubis symphysis and 11 millimeters trocar was fixed through exposed fascia using open technique. Five mm port was placed under direct vision at the umbilicus for camera insertion and two 3.5 mm ports were placed in subxiphoid and paraumbilical area. sLDN: Ten mm port was placed at umbilicus using open access technique for camera insertion. Five mm trocar for grasping and 11 mm trocar for vascular clipping were placed at subxiphoid and paraumbilical areas under direct vision, respectively. The second 5 mm trocar was placed in suprapubic area. Cosmetic appearance was assessed three months after surgery by using the Patient Scar Assessment Questionnaire (PSAQ).

RESULTS

Demographic data of the patients was not significantly different between two groups. Total operative time and ischemic time was nearly similar in both groups (104 ± 21 vs. 114 ± 24 min; P = .327 and 4.03 vs. 4.07 min; P = .592). There were no cases of conversion to open surgery. Mean hospital stay was similar between the two groups [2.1 (2-5) vs. 2.4 (2-5) days; P = .346]. Kidney graft function assessed by serum creatinine values (mg/dL) of recipients, was equivalent in both groups (1.58 vs. 1.86: P = .206). Mean appearance score (34 vs. 29) and consciousness score (22 vs. 18) in PSAQ showed significantly better results in the mLDN group.

CONCLUSION

Our experience in this study revealed that peri- and post-operative findings were comparable between sLDN and mLDN, but mLDN has significant better cosmetic appearance than standard laparoscopic approach.

目的

本研究旨在通过一项随机临床试验比较标准腹腔镜活体供肾切除术（sLDN）和迷你腹腔镜供肾切除术（mLDN）的安全性、有效性及美容效果。

材料与方法

2012年3月至2013年6月，100例连续的肾供体被随机分为两组，进行腹腔镜供肾切除术。mLDN组：在耻骨联合上方稍作6至8厘米的Pfannenstiel切口，采用开放技术通过暴露的筋膜固定11毫米套管针。在直视下于脐部放置5毫米端口用于插入摄像头，在剑突下和脐旁区域放置两个3.5毫米端口。sLDN组：采用开放入路技术在脐部放置10毫米端口用于插入摄像头。在直视下分别于剑突下和脐旁区域放置5毫米抓持套管针和11毫米血管夹闭套管针。第二个5毫米套管针置于耻骨上区域。术后三个月使用患者瘢痕评估问卷（PSAQ）评估美容外观。

结果

两组患者的人口统计学数据无显著差异。两组的总手术时间和缺血时间相近（104±21对114±24分钟；P = 0.327；4.03对4.07分钟；P = 0.592）。无转为开放手术的病例。两组的平均住院时间相似[2.1（2 - 5）对2.4（2 - 5）天；P = 0.346]。通过受者血清肌酐值（mg/dL）评估的肾移植功能在两组中相当（1.58对1.86；P = 0.206）。PSAQ中的平均外观评分（34对29）和满意度评分（22对18）显示mLDN组的结果明显更好。