Division of Surgery, Department of Surgery, Cambridge University Hospitals, Addenbrooke's, Cambridge, United Kingdom.
Division of Surgery, Department of Surgery, Cambridge University Hospitals, Addenbrooke's, Cambridge, United Kingdom.
Urology. 2020 Sep;143:142-146. doi: 10.1016/j.urology.2020.05.068. Epub 2020 Jun 17.
To compare the outcomes of a transverse suprapubic incision with peritoneal access through the midline (SPM) and an iliac fossa muscle splitting (IFMS) incision for kidney retrieval during laparoscopic donor nephrectomy (LDN).
This observational retrospective comparative cohort study was performed using data from a prospectively maintained database to compare the outcomes of 2 different incisions (SPM n = 35 and IFMS n = 35) used for kidney retrieval during LDN. All incisions were infiltrated with local anesthesia at the time of closure. The primary outcome measure was postoperative analgesic requirements. Secondary outcome measures included donor complication rates and recipient outcomes. Selection bias was minimized by the study of 2 consecutive series of donors.
Overall, 28 of the 70 (40%) of the total cohort were male. There was no difference between age (IFMS 49 ± 12 vs SPM 49 ± 11 years, P = .317), body mass index (IFMS 26.5 ± 3.9 vs SPM 25.9 ± 3.3 kg/m, P = .493), and total postoperative opioid analgesic requirements (IFMS 213 ± 168 vs SPM 211 ± 168 mg, P = .807) between the 2 groups. The volume of local anesthetic infiltrated during wound closure was higher in the IFMS 0.470 ± 0.160 vs SPM 0.370 ± 0.234 mL/kg (P = .030) and associated with a reduction in postoperative opioid requirements (r = -0.511, P = .002). There were no major donor or recipient postoperative complications in either group and no difference in renal allograft function at 3-, 6-, 9-, or 12 months post-transplant.
An iliac fossa muscle splitting incision is a straightforward and safe approach, providing a reasonable alternative to the more traditional and widely used suprapubic incision for kidney retrieval during LDN.
比较经耻骨上横向切口联合腹腔中线入路（SPM）与经髂腰肌劈开切口（IFMS）用于腹腔镜供肾切取术（LDN）时取肾的效果。
本研究为前瞻性数据库的回顾性观察性比较队列研究，比较了两种不同切口（SPM 组 35 例和 IFMS 组 35 例）用于 LDN 时取肾的效果。所有切口在缝合时均采用局部麻醉浸润。主要观察指标为术后镇痛需求。次要观察指标包括供者并发症发生率和受者结局。通过对 2 组连续系列供者的研究，尽量减少选择偏倚。
总共有 70 名供者中的 28 名（40%）为男性。两组之间的年龄（IFMS 49 ± 12 岁 vs. SPM 49 ± 11 岁，P=0.317）、体质量指数（IFMS 26.5 ± 3.9 千克/平方米 vs. SPM 25.9 ± 3.3 千克/平方米，P=0.493）和总术后阿片类镇痛药需求（IFMS 213 ± 168 毫克 vs. SPM 211 ± 168 毫克，P=0.807）均无差异。IFMS 组切口闭合时局部麻醉浸润量为 0.470 ± 0.160 毫升/千克，高于 SPM 组的 0.370 ± 0.234 毫升/千克（P=0.030），且与术后阿片类药物需求减少相关（r=-0.511，P=0.002）。两组均无主要供者或受者术后并发症，移植后 3、6、9 和 12 个月时，肾移植功能也无差异。
经髂腰肌劈开切口是一种简单、安全的方法，为 LDN 时取肾提供了一种合理的替代传统且广泛应用的耻骨上切口的选择。
