Transplant Outcomes Research, Department of General Surgery, Section of Abdominal Organ Transplant, Washington University in Saint Louis, 660 S. Euclid Ave, Campus Box 8109, Saint Louis, MO, 63110, United States.
Transplant Outcomes Research, Department of General Surgery, Section of Abdominal Organ Transplant, Washington University in Saint Louis, 660 S. Euclid Ave, Campus Box 8109, Saint Louis, MO, 63110, United States.
Int J Surg. 2018 May;53:339-344. doi: 10.1016/j.ijsu.2018.04.003. Epub 2018 Apr 11.
Increasing use of Living Donor Kidney Transplantation (LDKT) would decrease the discrepancy between patients awaiting transplantation and organ availability. Minimally invasive surgical approaches attempt to improve outcomes and foster living donation. This report compares outcomes of open minimal incision nephrectomy (Mini N) and a hand assisted laparoscopic nephrectomy (HALN).
This is a retrospective analysis of a prospectively maintained clinical database of LDKT using HALN or Mini N at a single institution between July 2007 and December 2015. Donor and recipient demographics, relevant pre-, intra- and post-operative factors, outcomes such as patient and graft survival rates, and complications were evaluated.
Four hundred and fifty-four adult LDKT (243 Mini N, 211 HALN) were performed during the study period. Recipient and donor demographics were comparable except for higher BMI (p = 0.027) in HALN donors. One-, 3- and 5-year patient and graft survival rates were comparable. Six HALN donors experienced infectious wound complications or superficial skin dehiscence; none did in the Mini N group (p = 0.009). Eight HALN donors and one Mini N donor required an incisional hernia repair (p = 0.014). Recipients had similar warm ischemia times (33 v. 35 min, p = 0.491), but recipient surgeons of HALN nephrectomies subjectively noted higher anastomotic difficulty (10.4% v. 4.5%, p = 0.0183). Other parameters were similar between groups.
Both Mini N and HALN provide similar long term recipient and donor outcomes. Offering techniques such as Mini N and HALN for living donor kidney procurement facilitates the opportunity to provide living donors safer and better tolerated nephrectomy procedures.
增加活体供肾移植（LDKT）的使用可以减少等待移植的患者与器官可获得性之间的差距。微创外科方法旨在改善结果并促进活体捐献。本报告比较了开放微创切口肾切除术（Mini N）和手助腹腔镜肾切除术（HALN）的结果。
这是对 2007 年 7 月至 2015 年 12 月在一家单中心使用 HALN 或 Mini N 进行的 LDKT 的前瞻性维护临床数据库的回顾性分析。评估了供体和受体的人口统计学特征、相关的术前、术中及术后因素、患者和移植物存活率等结果以及并发症。
在研究期间，共进行了 454 例成人 LDKT（243 例 Mini N，211 例 HALN）。受体和供体的人口统计学特征相似，但 HALN 供体的 BMI 较高（p=0.027）。1、3 和 5 年的患者和移植物存活率相当。6 例 HALN 供体发生感染性伤口并发症或浅表皮肤裂开；而在 Mini N 组中没有（p=0.009）。8 例 HALN 供体和 1 例 Mini N 供体需要进行切口疝修补术（p=0.014）。受体的热缺血时间相似（33 分钟比 35 分钟，p=0.491），但 HALN 肾切除术的受体外科医生主观地认为吻合困难更大（10.4%比 4.5%，p=0.0183）。两组之间的其他参数相似。
Mini N 和 HALN 均可提供相似的长期受体和供体结果。提供 Mini N 和 HALN 等技术来获取活体供肾，可以为活体供者提供更安全、更耐受的肾切除术。
