Clinical analysis of hand-assisted retroperitoneoscopic and open living donor nephrectomy
GUO Shuang1, LI Xuanpeng1, MAN Jiangwei1, JIANG Chunqian2, NIU Jiping1, HAN Yuanming1, FU Shengjun1, YANG Li1
1 Department of Urology, Lanzhou University Institute of Urology, Gansu Nephron-Urological Clinical Center, Gansu Provincial Key Laboratory of Urological System Diseases, Lanzhou University Second Hospital, Lanzhou 730030, China; 2 Department of Pediatrics, Lanzhou University Second Hospital
摘要目的 比较手助后腹腔镜活体供肾切取术（HRPLDN）和开放活体供肾切取术（ODN）临床效果和安全性。方法 回顾性分析兰州大学第二医院2008年1月–2018年1月同期行HRPLDN 43例和ODN 47例患者资料,比较供者手术时间、热缺血时间、动静脉长度、输尿管长度、切口长度、出血量和围手术期并发症,比较术后24 h尿量、术后3 d内需用止痛药、住院时间和术后并发症发生的情况,比较以术后1周、1个月和3个月为时间点统计的肾功能指标,随访供、受者恢复情况。结果 90例供者手术均顺利完成,移植手术均获成功,HRPLDN组无术中转开放者,HRPLDN组和ODN组热缺血时间为（92.2±17.5）s vs. （80.2±16.3）s;出血量为（67.9±26.1）mL vs. （80.0±25.6）mL;切口长度为（9.2±1.0）cm vs. （13.3±1.6）cm;术后住院时间为（5.7±1.7）d vs. （6.8±2.1）d;术后3 d需止痛患者分别为1和8例,两组上述数据比较均差异有统计学意义(P<0.05)。手术时间、动静脉长度、输尿管长度和术后24 h尿量均差异无统计学意义(P>0.05),术后7 d、1个月及3个月肌酐水平均差异无统计学意义(P>0.05)。HRPLDN组术后切口脂肪液化1例,ODN组术后切口脂肪液化2例,切口感染1例。HRPLDN组和ODN组受者发生急性排斥反应分别为2和3例,发生移植肾功能延迟恢复各1例,其余受者肾功能均恢复良好。结论 HRPLDN与ODN均安全可靠,HRPLDN较ODN创伤小、出血少、美容效果好,缩短了住院时间,可替代ODN作为首选的治疗手段。
Abstract：Objective： To compare the clinical efficacy and safety of hand-assisted retroperitoneoscopic live donor nephrectomy (HRPLDN) and open living donor nephrectomy (ODN). Methods： The clinical data of 43 patients with HRPLDN and 47 patients with ODN in the Second Hospital of Lanzhou University from January 2008 to January 2018 were retrospectively analyzed. The donor's operation time, warm ischemia time, arteriovenous length, ureter length, incision length and bleeding volume and perioperative complication were compared. The 24 h urine volume, painkillers within 3 days after surgery, hospitalization time and postoperative complications were also compared. At the same time, the renal function indicators and the recovery of donors and recipients at 1st week, 1st month and 3rd month after surgery were compared. Results： All the surgical operations of 90 donors and all transplantations were performed successfully. There was no intraoperative conversion to open surgery in the HRPLDN group, and the time of warm ischemia in HRPLDN group and ODN group was (92.2±17.5) s vs. (80.2±16.3) s respectively with significant difference (P<0.05). The bleeding volume and incision length in HRPLDN group and ODN group were (67.9±26.1) vs. (80.0±25.6) mL and (9.2±1.0) vs. (13.3±1.6) cm respectively, with significant difference (P<0.05). Postoperative hospital stay in HRPLDN group and ODN group was (5.7±1.7) vs. (6.8±2.1) days, with significant difference (P<0.05). Postoperative analgesia at 3rd day was given for 1 case and 8 cases in HRPLDN group and ODN group respectively, with the significant difference (P<0.05). There was no significant difference in operative time, arteriovenous length, length of ureter and urine volume at 24 h after operation (P>0.05). There was no significant difference in creatinine levels at 7th, 1st and 3rd month after operation (P>0.05). In the HRPLDN group, there was 1 case of incision fat liquefaction. In the ODN group, incision fat liquefaction occurred in 2 cases and incision infection in 1 case. The number of acute rejection in the HRPLDN group and the ODN group was 2 and 3, respectively. There was 1 case of delayed graft function recovery in each group, and the renal function of the other recipients recovered well. Conclusion： Both HRPLDN and ODN are safe and reliable. Compared with ODN, HRPLDN has less trauma, less bleeding, better cosmetic effect and shorter hospitalization time, which can replace ODN as the preferred treatment.
郭霜, 李选鹏, 满江位, 姜春倩, 牛纪平, 韩渊明, 付生军, 杨立. 手助后腹腔镜和开放活体供肾切取术的临床分析[J]. 微创泌尿外科杂志, 2019, 8(1): 1-6.
GUO Shuang, LI Xuanpeng, MAN Jiangwei, JIANG Chunqian, NIU Jiping, HAN Yuanming, FU Shengjun, YANG Li. Clinical analysis of hand-assisted retroperitoneoscopic and open living donor nephrectomy. JOURNAL OF MINIMALLY INVASIVE UROLOGY, 2019, 8(1): 1-6.
[1] 石炳毅,林涛,蔡明.中国活体供肾移植临床指南(2016版).器官移植,2016,7(6):417-426. [2] COZZI E, BIANCONE L, LÓPEZ-FRAGA M, et al. Long-term Outcome of Living Kidney Donation, Position Paper of the European Committee on Organ Transplantation, Council of Europe. Transplantation, 2016,100(2):270-271. [3] 冀涛,刘隆,王秋生.手助腹腔镜手术.中国微创外科杂志,2005,5(1):80-82. [4] TUSHLA L, RUDOW DL, MILTON JA, et al.Living-Donor kidney transplantation: reducing financial barriers to live kidney Donation-Recommendations from a consensus conference. Clin J Am Soc Nephrol, 2015,10(9):1696-1702. [5] GOZDOWSKA J, ZATORSKI M, TORCHALLA P, et al.Living-Donor versus Deceased-Donor kidney transplantation: comparison of psychosocial Consequences for recipients. Transplant Proc, 2016,48(5):1498-1505. [6] BRANCO F, CAVADAS V, ROCHA A, et al.Living versus cadaveric-donor renal transplant recipients: a comparison on sexual function. Transplant Proc, 2013,45(3):1066-1069. [7] WILSON CH, SANNI A, RIX DA, et al. Laparoscopic versus open nephrectomy for live kidney donors. Cochrane Database Syst Rev, 2011,(11)CD006124. [8] WOLF JS JR, TCHETGEN MB, MERION RM.Hand-assisted laparoscopic live donor nephrectomy. Urology, 1998,52(5):885-887. [9] YUAN H, LIU L, ZHENG S, et al.The safety and efficacy of laparoscopic donor nephrectomy for renal transplantation: an updated meta-analysis. Transplant Proc, 2013,45(1):65-76. [10] 李涛,付生军,董治龙,等.手助腹腔镜与开放手术活体供肾取肾术的系统评估.器官移植,2014,5(2):68-73. [11] ELMARAEZY A, ABUSHOUK AI, KAMEL M, et al.Should hand-assisted retroperitoneoscopic nephrectomy replace the standard laparoscopic technique for living donor nephrectomy? A meta-analysis. Int J Surg, 2017,40(4):83-90. [12] LIM J, KONG YG, KIM YK, et al.Risk factors associated with decreased renal function after Hand-Assisted laparoscopic donor nephrectomy: a multivariate analysis of a single surgeon experience. Int J Med Sci, 2017,14(2):159-166. [13] ÖZDEMIR-VAN BRUNSCHOT DM, KONING GG, VAN LAARHOVEN KC, et al. A comparison of technique modifications in laparoscopic donor nephrectomy: a systematic review and meta-analysis. PLoS One, 2015,10(3):e0121131. [14] KUMAR S, WITT RG, TULLIUS SG, et al.Hand-assisted laparoscopic retroperitoneal donor nephrectomy: A single-institution experience of over 500 cases Operative technique and clinical outcomes. Clin Transplant, 2018,32(6):e13261. [15] WIDMER JD, SCHLEGEL A, KRON PA, et al.Hand-assisted living-donor nephrectomy: a retrospective comparison of two techniques. BMC Urol, 2018,18(1):39. [16] BEMELMAN WA, VANDOORN RC, DE WIT LTH, et al.Hand-assisted laparoscopic live donor nephrectomy-initial experience. S Afr J Surg, 2011,49(1):18-21. [17] GRECO F, HODA MR, ALCARAZ A, et al.Laparoscopic Living-Donor nephrectomy: analysis of the existing literature. Eur Urol, 2010,58(4):498-509. [18] GARCIA CL, PRIETO OP, BAHENA PA, et al.Experience and security of the Hand-Assisted laparoscopic nephrectomy of a living donor in a public health center. Transplant Proc, 2018,50(2):433-435. [19] 成柯,刘炼,王强,等.手助腹腔镜与开放手术活体供肾切取术的临床研究.中华移植杂志(电子版),2014,8(4):191-195. [20] BARON PW, BEN YR, OJOGHO ON, et al.Morbidity of 200 consecutive cases of hand-assisted laparoscopic living donor nephrectomies: a single-center experience. J Transplant, 2012,2012,121523. [21] LENTINE KL, LAM NN, AXELROD D, et al.Perioperative complications after living kidney donation: a National study. Am J Transplant, 2016,16(6):1848-1857.
