双极血管密封系统与丝线结扎在肾移植受者淋巴并发症中的应用：一项随机对照试验。

Bipolar vessel sealing system versus silk ligation of lymphatic vessels in renal transplant recipient lymphatic complications: a randomized controlled trial.

机构信息

Department of Urology and Kidney Transplant Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal.

Department of Community Health Sciences, Patan Academy of Health Sciences, Patan, Nepal.

出版信息

Int Urol Nephrol. 2021 Dec;53(12):2477-2483. doi: 10.1007/s11255-021-03003-5. Epub 2021 Oct 16.

DOI:10.1007/s11255-021-03003-5

PMID:34655393

Abstract

PURPOSE

This study was aimed to compare lymphatic complications of bipolar vessel sealing system with silk ligation of lymphatic vessels among renal transplant recipients.

METHODS

This was a prospective randomized controlled trial done among 68 patients undergoing renal transplantation in Tribhuvan University Teaching Hospital. They were randomly assigned to either silk ligation or Enseal bipolar vessel sealing lymphatic dissection. Postoperative drain volume and duration of drain placement were measured in all patients. Ultrasound was used to find lymphocele formation in six and 12 weeks.

RESULTS

Total of 30 patients in silk ligation group and 28 patients in bipolar vessel sealing group were analyzed. The baseline characteristics of the patients in each group were similar. Overall, lymphatic complications (either lymphorrhea or lymphocele formation) were in 16 cases (27.58%), 7 (25%) in the bipolar group, and 9 (30%) in the silk ligation group (p = 0.67). A total of 13 patients (22.41%) had lymphorrhea, 6 (21.4%) patients in the bipolar group, and 7 (23.3%) patients in the silk ligation group. Median drain volume was 415 ml (Q1 275 ml, Q3 675 ml) in the bipolar group and 542 ml (Q1 290, Q3 775) in silk group (p = 0.72). Median drain removal day was 5 in each bipolar and silk group with Q1 and Q3 being 5 days in each arm (p = 0.95). A total of five patients (8.62%) developed symptomatic lymphocele, two (7.1%) in the bipolar group, and three (10%) in the silk ligation group, but the difference was not statistically significant. In univariate analysis, double renal arteries in the donor's kidney (p = 0.03) and graft rejection (p = 0.04) were risk factors for the development of lymphatic complications. However, in multivariable analysis, these factors were not statistically significant.

CONCLUSIONS

This study did not find any significant differences in lymphatic complications between bipolar vessel sealing system and silk ligation. However, large sample multi-centric studies should be done to add evidences on lymphatic complications differences between these two techniques.

TRIAL REGISTRATION NUMBER

UMIN000039354, Date of registration-2020, Feb 01.

摘要

目的

本研究旨在比较双极血管密封系统与丝线结扎淋巴管在肾移植受者中的淋巴并发症。

方法

这是一项在特里布万大学教学医院进行的前瞻性随机对照试验，共纳入 68 例接受肾移植的患者。他们被随机分配到丝线结扎组或 Enseal 双极血管密封淋巴解剖组。所有患者均测量术后引流量和引流管放置时间。术后 6 周和 12 周行超声检查发现淋巴囊肿形成。

结果

丝线结扎组 30 例，双极血管密封组 28 例。两组患者的基线特征相似。总的来说，淋巴并发症（淋巴漏或淋巴囊肿形成）在 16 例（27.58%）中，双极组 7 例（25%），丝线结扎组 9 例（30%）（p=0.67）。淋巴漏的总病例数为 13 例（22.41%），双极组 6 例（21.4%），丝线结扎组 7 例（23.3%）。双极组的中位引流量为 415ml（Q1 275ml，Q3 675ml），丝线组为 542ml（Q1 290ml，Q3 775ml）（p=0.72）。双极组和丝线组的中位引流管拔除天数均为 5 天，Q1 和 Q3 均为 5 天（p=0.95）。共有 5 例（8.62%）患者发生症状性淋巴囊肿，双极组 2 例（7.1%），丝线结扎组 3 例（10%），但差异无统计学意义。单因素分析显示，供体肾脏的双肾动脉（p=0.03）和移植物排斥（p=0.04）是发生淋巴并发症的危险因素。然而，多变量分析显示，这些因素无统计学意义。