腹腔镜与开放手术活体取肾供者1年随访研究  

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

作　　者：高振利[1] 赵俊杰[1] 孙德康[1] 柳东夫[1] 王琳[1] 杨典东[1] 姜仁慧[1] 王建明[1] 石磊[1] 万峰春[1] 方艳丽[1] 王科[1] 

机构地区：[1]青岛大学医学院附属烟台毓璜顶医院泌尿外科,264000

出　　处：《中华泌尿外科杂志》2008年第9期598-602,共5页Chinese Journal of Urology

摘　　要：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、24h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（98．6±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）、（206．3±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（28．5±2．9）、（25．8±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±9．5）、（96．6士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）、（90．3±11．7）μmol／L。2组术后6个月时平均GFR值分别为64．7、65．8ml／min，术后1年时为65．9、67．5ml／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组间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24h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。Objective To compare the safety of laparoscopic live donor nephrectomy（LDN） and open live donor nephreetomy（ODN）, evaluate the kidney function and blood pressure of living donors during 1 year follow-up. Methods Thirty cases of LDN and 30 cases 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 classification system procedure-related complications were described and compared. Serum creatinine（SCr） le- vels, blood pressure and 24-h urine protein excretion were measured before nephrectomy 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, respectively. 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±34.8）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±3.8）h, ODN group was （38.6±3.3）h and （36.5±5.3）h（P〈0.01）. Perioperative complications rates were 6.6 % （2/30） and 23.3 % （7/30） for LDN and ODN, respectively. SCr was （109.1±7.5）, （105.4±9.5）, （96.6±10.7） ,（89.4±11.5） ,（91.6±9.3）μmol/L in the LDN group and （107.3±9.6）, （103.3±8.4）, （95.4±9.1）, （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

关 键 词：腹腔镜 肾移植 活体供者 随访 

分 类 号：R699[医药卫生—泌尿科学]