Broe Mark P, Galvin Rose, Keenan Lorna G, Power Richard E
Department of Urology and Renal Transplantation, Beaumont Hospital, Dublin, Ireland.
Department of Postgraduate Studies, Royal College of Surgeons in Ireland, Dublin, Ireland.
Arab J Urol. 2018 Jul 7;16(3):322-334. doi: 10.1016/j.aju.2018.02.003. eCollection 2018 Sep.
To compare the perioperative outcomes of hand-assisted laparoscopic donor nephrectomy (HALDN) and pure LDN, as HALDN and LDN are the two most widely used techniques of DN to treat end-stage renal disease.
In this systematic review and meta-analysis, we performed a literature search of PubMed, Embase, Web of Science, and Cochrane from 01/01/1995 to 31/12/2014. The primary outcome was conversion to an open procedure. Secondary outcomes were warm ischaemia time (WIT), operation time (OT), estimated blood loss (EBL), complications, and length of stay (LOS). Data analysed were presented as odds ratios (ORs) or weighted mean differences (WMDs) with 95% confidence intervals (CIs), , and values. Subgroup analysis was performed.
There were 24 studies included in the meta-analysis; three randomised controlled trials (RCTs), one randomised pilot study, two prospective, and 18 retrospective cohort studies. There were no differences in conversion to an open procedure between the two techniques for both RCTs (OR 0.42, 95% CI 0.06, 2.90; = 0%, < 0.001) and cohort studies (OR 1.06, 95% CI 0.63, 1.78; = 0%, = 0.84). WIT was shorter for the HALDN (-41.79 s, 95% CI -71.85, -11.74; = 96%, = 0.006), as was the OT (-26.32 min, 95% CI -40.67, -11.97; = 95%, < 0.001). There was no statistically significant difference in EBL, complications or LOS.
There is little statistical evidence to recommend one technique. HALDN is associated with a shorter WIT and OT. LDN has equal safety to HALDN. Further studies are required.
比较手辅助腹腔镜供肾切除术（HALDN）和单纯腹腔镜供肾切除术（LDN）的围手术期结果，因为HALDN和LDN是治疗终末期肾病最常用的两种供肾切除术技术。
在这项系统评价和荟萃分析中，我们对1995年1月1日至2014年12月31日期间的PubMed、Embase、Web of Science和Cochrane数据库进行了文献检索。主要结局是转为开放手术。次要结局包括热缺血时间（WIT）、手术时间（OT）、估计失血量（EBL）、并发症和住院时间（LOS）。分析的数据以比值比（OR）或加权平均差（WMD）及95%置信区间（CI）、 、 值表示。进行了亚组分析。
荟萃分析纳入了24项研究；3项随机对照试验（RCT）、1项随机先导研究、2项前瞻性研究和18项回顾性队列研究。对于RCT（OR 0.42，95%CI 0.06，2.90； = 0%， < 0.001）和队列研究（OR 1.06，95%CI 0.63，1.78； = 0%， = 0.84），两种技术在转为开放手术方面均无差异。HALDN组的WIT较短（-41.79秒，95%CI -71.85，-11.74； = 96%， = 0.006），OT也较短（-26.32分钟，95%CI -40.67，-11.97； = 95%， < 0.001）。EBL、并发症或LOS方面无统计学显著差异。
几乎没有统计学证据支持推荐其中一种技术。HALDN与较短的WIT和OT相关。LDN与HALDN具有同等安全性。需要进一步研究。
