1 Division of Transplantation, Department of Surgery, University of Minnesota, Minneapolis, MN. 2 Biostatistics and Bioinformatics Core, Masonic Cancer Center, University of Minnesota, Minneapolis, MN. 3 Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN.
Transplantation. 2016 Jun;100(6):1299-305. doi: 10.1097/TP.0000000000001251.
The development of minimally invasive surgical approaches to donor nephrectomy (DN) has been driven by the potential advantages for the donor, with questions remaining about long-term outcomes.
All living DN performed from June 1963 through December 2014 at the University of Minnesota were reviewed. Outcomes were compared among 4 DN techniques.
We performed 4286 DNs: 2759 open DN (ODNs), 1190 hand-assisted (HA) laparoscopic DNs (LDNs), 203 pure LDN (P-LDNs), and 97 robot-assisted-LDN. Laparoscopic DN was associated with an older (P < 0.001) and heavier (P < 0.001) donor population. Laparoscopic DN was associated with a higher probability of left kidney procurement (P < 0.001). All 3 LDN modalities required a longer operative time (P < 0.001); robot-assisted-LDN took significantly longer than HA-LDN or P-LDN. Laparoscopic DN decreased the need for intraoperative blood transfusion (P < 0.001) and reduced the incidence of intraoperative complications (P < 0.001) and hospital length of stay (P < 0.001). However, LDN led to a significantly higher rate of readmissions, both short-term (<30 day, P < 0.001) and long-term (>30 day, P < 0.001). Undergoing HA-LDN was associated with a higher rate of an incisional hernia compared with all other modalities (P < 0.001). For recipients, LDN seemed to be associated with lower rates of graft failure at 1 year compared with ODN (P = 0.002). The odds of delayed graft function increased for kidneys with multiple arteries procured via P-LDN compared with HA-LDN (OR 3 [1,10]) and ODN (OR 5 [2, 15]).
In our experience, LDN was associated with decreased donor intraoperative complications and hospital length of stay but higher rates of readmission and long-term complications.
微创外科方法在供肾切除术（DN）中的应用是由供体的潜在优势驱动的，但是长期结果仍存在疑问。
回顾了 1963 年 6 月至 2014 年 12 月在明尼苏达大学进行的所有活体供肾切除术。比较了 4 种供肾切除术技术的结果。
我们共进行了 4286 例供肾切除术：2759 例开放供肾切除术（ODN），1190 例手助腹腔镜供肾切除术（HA-LDN），203 例纯腹腔镜供肾切除术（P-LDN）和 97 例机器人辅助腹腔镜供肾切除术。腹腔镜供肾切除术与供体年龄较大（P <0.001）和体重较重（P <0.001）有关。腹腔镜供肾切除术更有可能获取左侧肾脏（P <0.001）。所有 3 种腹腔镜供肾切除术方式的手术时间均较长（P <0.001）；机器人辅助腹腔镜供肾切除术的手术时间明显长于手助腹腔镜供肾切除术或纯腹腔镜供肾切除术。腹腔镜供肾切除术减少了术中输血的需求（P <0.001），并降低了术中并发症（P <0.001）和住院时间（P <0.001）的发生率。然而，腹腔镜供肾切除术导致短期（<30 天，P <0.001）和长期（>30 天，P <0.001）再入院率显著升高。与其他所有方式相比，手助腹腔镜供肾切除术与更高的切口疝发生率相关（P <0.001）。对于接受者，与 ODN 相比，LDN 在 1 年内似乎与较低的移植物失败率相关（P = 0.002）。与 HA-LDN 和 ODN 相比，通过 P-LDN 获得多支动脉的肾脏发生延迟移植物功能的几率更高（OR 3 [1,10]和 OR 5 [2,15]）。
根据我们的经验，腹腔镜供肾切除术与供体术中并发症和住院时间减少有关，但再入院率和长期并发症发生率较高。
