腹腔镜与开放手术活体取肾供者1年随访研究

目的 比较腹腔镜活体取肾(LDN)与开放手术活体取肾(ODN)的手术安全性及供者术后1年肾功能及血压状况. 方法LDN和ODN各30例,比较2组手术时间、热缺血时间、术中失血量、术后开始进食时间及术后开始下床活动时间,并根据改良Clavien分级系统统计2组围手术期并发症情况.对2组供者术前及术后第1天、1周、3、6个月、1年的血肌酐、血压、24 h尿蛋白定量水平和术前及术后6个月、1年时的肾小球滤过率(GFR)值进行统计比较. 结果 LDN组和ODN组手术时间分别为(98.65±13.6)、(96.3±19.5)min,热缺血时间为(90.6±15.1)、(86.4±12.3)s,2组术中失血量为(105.2±34.8)、(206.35±126.4)ml(P<0.01).术后开始进食及开始下床活动时间LDN组分别为(28.55±2.9)、(25.85±3.8)h,ODN组分别为(38.6±3.3)、(36.5±5.3)h(P值均<0.01).LDN和ODN组围手术期并发症总发生率分别为6.6%(2/30)和23.3%(7/30).术后第1天、1周、3个月、6个月、1年时血肌酐水平LDN组为(109.1±7.5)、(105.4士9.5)、(96.6±10.7)、 (89.4±11.5)、(91.6±9.3)μmol/L,ODN组为(107.3±9.6)、(103.3±8.4)、(95.4±9.1)、(90.5±13.6)、(90.35±11.7)μmol/L.2组术后6个月时平均GFR值分别为64.7、65.8 ml/min,术后1年时为65.9、67.5 ml/min,与术前相比差异均有统计学意义(P<0.05),术后1年与术后6个月时相比及2组问同期比较差异均无统计学意义(P>0.05).术后1年内2组平均24 h尿蛋白定量水平及血压与术前相比及2组间同期比较差异均无统计学意义(P>0.05). 结论 LDN具有创伤小,出血少、恢复快的优点,手术安全性与ODN相当,术后1年内对供者的肾功能及血压无明显不良影响.

One year follow-up of living kidney donors of laparoscopic and open live donor nephrectomy

Objective To compare the safety of laparoscopic live donor nephreetomy(LDN) and open live donor nephrectomy(ODN), evaluate the kidney function and blood pressure of living donors during 1 year follow-up. Methods Thirty cases of LDN and 30 eases of ODN were retrospectively reviewed. The operation time, warm ischemia time, operative blood loss, time to post-operative intake and time to ambulation of the 2 grouups were compared. According to the modified Clavien classifica-tion system procedure-related complications were described and compared. Serum creatinine(SCr) le-vels, blood pressure and 24-h urine protein excretion were measured before nephreetomy and 1 d, 7 d, 3 months, 6 and 12 months after nephrectomy. Glomerular filtration rate (GFR) were measured preo-pratively and at 6 and 12 months postoperatively. These data were statistically analyzed. Results The operation time was (98. 6+13. 6)rain and (96.3+19. 5)rain in the LDN and ODN groups, re- spectively. Warm ischemia time in the LDN group was (90.6±15.1)s, in the ODN group was (86.4±12.3)s. Operative blood loss was (105.2±634.8)ml and (206.3±126.4)ml in the LDN and ODN groups(P<0.01). For the time to post-operative intake and time to ambulation, LDN group was (28.5±2.9)h and (25.8±63.8)h, ODN group was (38.6±63.3)h and (36.5±65.3)h(P<0.01). Perioperative complications rates were 6.6%(2/30) and 23.3%(7/30) for LDN and ODN, respective-ly. SCr was (109.1±7.5), (105.4±69.5), (96.6±10.7), (89.4±11.5), (91.6±69.3)/zmol/L in the LDN group and (107.3±69.6), (103.3±68.4), (95.4±69.1), (90.5±13.6), (90.3±11.7)μmol/L in the ODN group 1 day, 7 days, 3 months, 6 months and 12 months after nephrectomy. The mean GFR of LDN and ODN was 64.7 and 65.8 ml/min at 6 months after nephrectomy, 65.9 and 67.5 ml/min at 12 months postoperatively, which were significantly different comparing with preoperative mean GFR in each group(P<0.05) but no significant difference was found between 6 months and 12 months after nephrectomy and between the 2 groups at the same time point respectively(P>0.05). Mean 24 h protein excretion was elevated after either LDN or ODN during 1 year followup, but was not significantly different either between predonation and 1 year after nephrectomy or between the 2 groups at the same period. Blood pressure increased or decreased slightly with the duration of follow-up,no significant blood presure changes were found before and after nephrectomy or between the two groups at the same period postoperatively. Conclusions LDN has the advantages of minimal trauma, less operative blood loss and quicker convalescence. It is safe and and has no adverse effects regarding kidney function and blood pressure during the first year after living kidney donation comparing to ODN.