Department of Urology, Singapore General Hospital, Singapore.
Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Investig Clin Urol. 2018 Jul;59(4):238-245. doi: 10.4111/icu.2018.59.4.238. Epub 2018 Jun 15.
Autosomal dominant polycystic kidney disease (ADPKD) is the most common hereditary kidney disease, and 20% of patients eventually require nephrectomies due to compressive symptoms or renal-related complications. Traditionally, nephrectomies were performed via the open approach in view of space constraints. We evaluate our institution's outcomes for laparoscopic nephrectomy (LN) for ADPKD.
We retrospectively reviewed 33 patients with ADPKD who underwent nephrectomies from November 2005 to December 2016 at a tertiary institution. Preoperative kidney volume was calculated via the ellipsoid method by using computed tomography scan.
The median age was 51.0 years (interquartile range [IQR], 44.5-56.0 years). Sixteen patients (48.5%) underwent open nephrectomy (ON), 15 patients (45.5%) had LNs, and 2 patients (6.1%) had laparoscopic converted to ON due to dense adhesions. Thirteen patients had bilateral while 18 patients had unilateral nephrectomies. Median kidney volume in the open group was 1,042 cm (IQR, 753-2,365 cm) versus 899 cm (IQR, 482-1,914 cm) in the laparoscopy group and did not differ significantly. The operative time was comparable between both groups. Patients who underwent LN had lesser blood loss (350 mL vs. 650 mL; 95% confidence interval [CI], 1.822-3.533; p=0.016) and shorter length of hospital stay (4.0 days vs. 6.5 days; 95% CI, 1.445-5.755; p=0.001) compared to patients who underwent ON. Both groups had similar low morbidity rate and no mortality.
LN for ADPKD is a safe and effective alternative to ON independent of kidney size with comparable outcomes and benefits of minimally invasive surgery.
常染色体显性遗传性多囊肾病（ADPKD）是最常见的遗传性肾脏疾病，20%的患者最终因压迫症状或与肾脏相关的并发症而需要进行肾切除术。传统上，由于空间限制，肾切除术是通过开放方法进行的。我们评估了我们机构在腹腔镜肾切除术（LN）治疗 ADPKD 方面的结果。
我们回顾性分析了 2005 年 11 月至 2016 年 12 月在一家三级医疗机构接受肾切除术的 33 例 ADPKD 患者。通过 CT 扫描的椭球法计算术前肾脏体积。
中位年龄为 51.0 岁（四分位距 [IQR]，44.5-56.0 岁）。16 例（48.5%）患者接受了开放性肾切除术（ON），15 例（45.5%）患者接受了 LN，2 例（6.1%）患者因粘连致密而转为 ON。13 例患者为双侧，18 例患者为单侧。ON 组中位肾脏体积为 1042cm（IQR，753-2365cm），而 LN 组为 899cm（IQR，482-1914cm），两组差异无统计学意义。两组的手术时间相当。LN 组患者出血量较少（350mL 比 650mL；95%置信区间 [CI]，1.822-3.533；p=0.016），住院时间较短（4.0 天比 6.5 天；95%CI，1.445-5.755；p=0.001）。与 ON 组相比，两组的发病率均较低，且均无死亡。
LN 治疗 ADPKD 是一种安全有效的替代 ON 的方法，与肾脏大小无关，具有微创外科手术的相似结果和益处。
