LAPAROSCOPIC LIVE DONOR NEPHRECTOMY—IS IT SAFE?: Analysis of 80 Consecutive Cases and Comparison with Open Nephrectomy
LAPAROSCOPIC LIVE DONOR NEPHRECTOMY—IS IT SAFE?: Analysis of 80 Consecutive Cases and Comparison with Open Nephrectomy
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腹腔镜活体供肾切除术——安全吗？：连续80例分析及与开腹肾切除术的比较
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发表时间：
1999
期刊：
影响因子：
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通讯作者：
F. Stuart
中科院分区：
文献类型：
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作者：
J. Leventhal;R. Deeik;R. Joehl;R. Rege;C. Herman;J. Fryer;D. Kaufman;M. Abecassis;F. Stuart
背景腹腔镜活体供肾切除术（LDN）是一种微创的替代开放式肾切除术（ODN）的活体供肾。人们对LDN的安全性、LDN切除的肾脏的短期和长期功能以及LDN移植受者中泌尿系统并发症的潜在较高发生率表示担忧。方法. 1997年10月至1999年5月，80 LDN在我们中心进行。所有患者均通过门诊和电话随访进行纵向随访。这些LDN进行了比较，从1996年1月至1997年10月的50 ODN。结果LDN手术时间显著长于ODN（4.6 vs 3.1小时）。然而，LDN与静脉麻醉剂使用的显著减少、快速恢复饮食和住院时间缩短相关。在80例LDN手术中，共有75例（94%）通过腹腔镜完成。5例患者转为剖腹手术：3例因出血，2例因复杂血管解剖。ODN转换与大供体体型和/或肥胖相关。7例LDN患者有轻微并发症，4例有严重并发症。所有重大并发症均包括血管损伤（2例腰静脉损伤、1例肾动脉损伤和1例主动脉损伤）。所有患者均完全康复。所有LDN肾脏在移植后立即发挥功能。我们已经观察到100%的患者和97%的LDN移植受者的1年精算移植物存活率。在这个系列中没有短期或长期的泌尿系统并发症。结论随着经验的增加和技术的标准化，LDN是一种安全有效的方法。与ODN患者相比，接受LDN的患者表现出临床意义，术后恢复更快，住院时间更短。在LDN肾中观察到了良好的移植肾初始功能和移植肾长期存活。可以避免泌尿系统并发症。LDN已成为我们中心活体肾脏捐赠的首选手术方法。
Background. Laparoscopic live donor nephrectomy (LDN) is a less invasive alternative to open nephrectomy (ODN) for living kidney donation. Concerns have been raised regarding the safety of LDN, the short and long term function of kidneys removed by LDN, and a potential higher incidence of urologic complications in LDN transplant recipients. Methods. Between October 1997 and May 1999, 80 LDNs were performed at our center. All patients were followed longitudinally with office visits and telephone interviews. These LDNs were compared with 50 ODN performed from January 1996 to October 1997. Results. LDN procedures took significantly longer than ODN (4.6 vs. 3.1 hr). However, LDN was associated with significant reduction in i.v. narcotic use, a rapid return to diet, and shorter hospital stay. Of the 80 LDN procedures, a total of 75 (94%) were completed laparoscopically. Five patients were converted to laparotomy: three for hemorrhage and two for complex vascular anatomy. ODN conversion was associated with large donor body habitus and/or obesity. Seven LDN patients had minor complications and 4 had major complications. All major complications consisted of vascular injuries (2 lumbar vein injuries, 1 renal artery, and 1 aortic injury). All patients made complete recoveries. All LDN kidneys functioned immediately posttransplant. We have observed 100% patient and 97% 1-year actuarial graft survival in LDN transplant recipients. There have been no short-or long-term urologic complications in this series. Conclusion. With increasing experience and standardization of technique, LDN is a safe and effective procedure. Patients undergoing LDN demonstrate clinically significant, more rapid postoperative recoveries and shorter hospital stays than ODN patients. Excellent initial graft function and long-term graft survival have been observed with LDN kidneys. Urologic complications can be avoided. LDN has become the preferred surgical approach for living kidney donation at our center.