Deshmukh Chaitanya S, Ganpule Arvind P, Sudharsan S Balaji, Singh Abhishek G, Sabnis Ravindra B, Desai Mahesh R
Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, India.
Arab J Urol. 2019 Jul 22;17(4):318-325. doi: 10.1080/2090598X.2019.1637069. eCollection 2019.
: To compare two retrieval incisions, Pfannenstiel vs iliac fossa incision, in terms of operative technique-related variables and variables related to patient satisfaction postoperatively, in patients undergoing laparoscopic donor nephrectomy (LDN). : This prospective randomised study was conducted between May 2016 and April 2017. All the voluntary kidney donors aged 18-60 years were randomised into two groups. Group 1, comprised patients undergoing graft retrieval via an iliac fossa incision, and Group 2 comprised those undergoing graft retrieval via a Pfannenstiel incision. Intraoperative assessment of the incision by the surgeon was done using a Likert scale-based questionnaire. Other variables studied were the operative time, retrieval time, warm ischaemia time, and length of incision. Postoperatively, visual analogue scale pain scores, analgesia consumption, and hospital stay were compared. During follow-up cosmetic outcome was compared. : In all, 108 patients were enrolled in the study with 54 patients in each group. The mean operative time was shorter in Pfannenstiel-incision group, at 155.2 vs 171.67 min ( = 0.01). The retrieval incision length was significantly less in the Pfannenstiel arm, at 9.29 vs 9.85 cm (< 0.001). In the surgeon Likert scale-based questionnaire, the Pfannenstiel incision scored better than the iliac fossa incision for ease of specimen retrieval ( = 0.015), ease of immediate check laparoscopy ( = 0.002), and ease of incision closure ( < 0.001). The Pfannenstiel-incision group required less postoperative analgesia, at a mean (SD) of 7.03 (8.82) vs 15.55 (11.1) mg nalbuphine ( < 0.001). During follow-up the Manchester Scar Scores were lesser in the Pfannenstiel-incision group ( < 0.001). : The Pfannenstiel incision was considered preferable during the critical steps of the LDN and had a smaller retrieval incision, lesser operative time and postoperative analgesia requirement, and better cosmesis than the iliac fossa incision. BMI: body mass index; LDN: laparoscopic donor nephrectomy; VAS: visual analogue scale; WIT, warm ischaemia time.
在接受腹腔镜供肾切除术（LDN）的患者中，比较两种取肾切口，即耻骨上横切口与髂窝切口，在手术技术相关变量及术后患者满意度相关变量方面的差异。：本前瞻性随机研究于2016年5月至2017年4月进行。所有年龄在18 - 60岁的自愿肾供体被随机分为两组。第1组为经髂窝切口取肾的患者，第2组为经耻骨上横切口取肾的患者。外科医生使用基于李克特量表的问卷对切口进行术中评估。研究的其他变量包括手术时间、取肾时间、热缺血时间和切口长度。术后比较视觉模拟评分法疼痛评分、镇痛药物用量和住院时间。随访期间比较美容效果。：总共108例患者纳入研究，每组54例。耻骨上横切口组的平均手术时间较短，为155.2分钟，而髂窝切口组为171.67分钟（P = 0.01）。耻骨上横切口组的取肾切口长度明显更短，为9.29厘米，而髂窝切口组为9.85厘米（P < 0.001）。在基于外科医生李克特量表的问卷中，耻骨上横切口在标本取出的难易程度（P = 0.015）、即时检查腹腔镜的难易程度（P = 0.002）和切口关闭的难易程度方面（P < 0.001）得分均高于髂窝切口。耻骨上横切口组术后所需镇痛药物较少，纳布啡平均（标准差）用量为7.03（8.82）毫克，而髂窝切口组为15.55（11.1）毫克（P < 0.001）。随访期间，耻骨上横切口组的曼彻斯特瘢痕评分更低（P < 0.001）。：在LDN的关键步骤中，耻骨上横切口被认为更可取，与髂窝切口相比，其取肾切口更小、手术时间更短、术后镇痛需求更少且美容效果更好。BMI：体重指数；LDN：腹腔镜供肾切除术；VAS：视觉模拟评分法；WIT：热缺血时间
