Donor nephrectomy: Mini-incision muscle-splitting open approach versus laparoscopy
Donor nephrectomy: Mini-incision muscle-splitting open approach versus laparoscopy
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DOI：
10.1097/01.tp.0000203320.74256.fd
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发表时间：
2006-03-27
期刊：
影响因子：
6.2
通讯作者：
IJzermans, JNM
中科院分区：
文献类型：
--
作者：
Kok, NFM;Alwayn, IPJ;IJzermans, JNM
背景腹腔镜供体肾切除术（LDN）的引入促进了微创开放技术的发展。本研究的目的是比较同期接受小切口开放式或腹腔镜肾脏捐献的供体的短期结果。从2001年5月至2004年9月，前瞻性收集所有活体肾脏捐献和移植的数据。51例供体行小切口、肌层劈开开放式供肾切除术（MIDN），49例供体行LDN。除供体性别外，研究组中供体和受体的基线特征相似。MIDN的中位切口长度为10.5 cm。2例患者LDN转为开放性。MIDN导致热缺血和手术时间显著缩短（分别为2.5 vs. 6.5 min和157 vs. 240 min）。在MIDN期间，供体失血更多（200 vs. 120 ml，P=0.02）。用于MIDN的一次性用品更便宜（328对1784欧元）。LDN组发生4例（8%）严重术中并发症和2例（4%）严重术后并发症，而MIDN组无严重并发症。吗啡需求，疼痛和恶心的感觉，以及饮食摄入时间在两组之间没有显着差异。MIDN后，供体出院较晚（4 vs. 3天，P=0.02）。两种方法获得的肾移植在第一年内导致血清肌酐类似的下降。MIDN和LDN组移植物1年存活率分别为100%和86%（P=0.005）。MIDN和LDN都能得到令人满意的结果。这两种技术都可以用于扩大活体捐赠计划。
Background. The introduction of laparoscopic donor nephrectomy (LDN) has encouraged the development of less invasive open techniques. Aim of the present study was to compare short-term outcomes between contemporary cohorts of donors who underwent either mini-incision open or laparoscopic kidney donation.Methods. From May 2001 to September 2004 data of all living kidney donations and transplantations were prospectively collected. Fifty-one donors underwent mini-incision, muscle-splitting open donor nephrectomy(MIDN) and 49 donors underwent LDN.Results. Baseline characteristics of donors and recipients in the study groups were comparable except for donors' gender. Median incision length in MIDN was 10.5 cm. In two patients LDN was converted to open. MIDN resulted in significantly shorter warm ischemia and operation time (2.5 vs. 6.5 min and 157 vs. 240 min respectively). During MIDN, donors had more blood loss (200 vs. 120 ml, P=0.02). Disposables used for MIDN were cheaper (328 vs. 1784 Euros). In the LDN group 4 (8%) major intraoperative and 2 (4%) major postoperative complications occurred versus no major complications in the MIDN group. Morphine requirement, pain and nausea perception, and time to dietary intake did not significantly differ between the groups. Following MIDN, donors were discharged later (4 vs. 3 days, P=0.02). Transplantation of kidneys procured by either approach led to a similar decline in serum creatinine throughout the first year. One-year graft survival was 100% following MIDN and 86% following LDN (P=0.005).Conclusion. MIDN and LDN both lead to satisfactory results. Both techniques can be used to expand living donor programs.