Hand-assisted retroperitoneoscopic live donor nephrectomy:: Experience from the first 75 consecutive cases
Hand-assisted retroperitoneoscopic live donor nephrectomy:: Experience from the first 75 consecutive cases
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DOI：
10.1097/01.tp.0000176477.81591.6f
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发表时间：
2005-10-27
期刊：
影响因子：
6.2
通讯作者：
Wadström, J
中科院分区：
文献类型：
--
作者：
Wadström, J
背景资料。与腹腔镜活体供肾切除术相关的两个主要危及生命的并发症是突发性严重出血和肠道损伤。手助和后腹腔镜术(HARS)相结合的技术降低了这些危及生命的并发症的风险。在这项研究中，我们报告了我们连续75次HARS手术的经验。这些数据是根据治疗意向前瞻性收集的，包括所有使用HARS技术进行手术的连续捐赠者。记录热缺血时间、手术时间和出血量。术后随访并发症、恢复期和同种异体移植结果，平均随访701d(范围601438天)。平均手术时间138(85~260)分钟，平均热缺血时间175(85~510)秒。男性捐献者的手术时间明显较长。术中平均出血176(50~700)ml，无中转开腹手术。主要并发症包括1个肺血栓和1个供者需要2个单位的输血。一名捐赠者因怀疑套管针疝气而再次手术。9例出现轻微并发症(发热4例，尿路感染2例，乳糜性腹水1例，痛1例，肋骨下痛1例)。除两个肾脏外，其余肾脏均立即开始起效。然而，这两者都不能归因于捐赠者的手术。一名受者发生尿漏，一名受者发生狭窄。受体和移植物存活率分别为99%和96%。我们的结论是，HARS能够缩短手术时间，同时显著降低与内窥镜活体供肾切除相关的风险，从而简化了这一过程。
Background. The two major life-threatening complications associated with laparoscopic live donor nephrectomy are sudden severe bleeding and intestinal injury. A combined technique-hand-assisted and retroperitoneoscopic (HARS)-reduces the risk of these life-threatening complications. In this study, we report on our experience from the first 75 consecutive HARS operations.Methods. The data has been collected prospectively according to intention to treat and includes all consecutive donors operated with the HARS technique. Warm ischemia time, operating time, and blood loss were recorded. Complications, convalescence, and allograft outcome were followed postoperatively with a mean follow-up of 701 (range 601438) days.Results. The mean operating time was 138 (range 85-260) minutes and the mean warm ischemia time 175 (85-510) seconds. The operative time was significantly longer in male donors. The mean bleeding was 176 (50-700) ml. There were no conversions to open surgery. Major complications comprised one pulmonary embolus and one donor required 2 units of blood transfusion. One donor was reoperated due to suspicion of trocar hernia. Nine patients experienced minor complications (fever, n=4; urinary tract infection, n = 2; chylous ascites, n = 1; orchialgia, n=1; subcostal pain, n=1). All except two kidneys had immediate onset of function. Neither of these could, however, be attributed to the donor operation. One recipient experienced urinary leakage and one a stenosis. Recipient and graft survival were 99% and 96%, respectively.Conclusions. We conclude that HARS facilitates the procedure by enabling short operating times and at the same time significantly reducing the risks associated with endoscopic live donor nephrectomy.