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目的 比较活体供肾移植中手助腹腔镜供肾切除 (Hand -assistedlaparoscopicdonornephrectomy ,HALDN)和完全腹腔镜活体供肾切除 (Laparoscopicdonornephrectomy,LDN)以及对供肾者和接受肾移植者的影响。 方法 回顾总结 1996年 10月～ 2 0 0 1年 2月MountSinai医学中心所有LDN和HALDN的病例资料。 1996年 10月开始行LDN手术 ,1999年 6月转而行HALDN手术。 结果 与LDN组相比 ,HALDN组手术时间明显缩短 ( ( 2 11± 7)minvs ( 2 5 7± 5 )min ,P <0 0 5 ) ,术中出血量明显减少 ( ( 12 2± 17)mlvs ( 2 86± 33)ml,P <0 0 5 ) ,肾脏热缺血时间明显缩短 ( ( 10 6± 6 )svs ( 2 5 7± 8)s,P <0 0 5 ) ,术后淋巴漏和血栓形成发生率 ( 0 %vs 13 7% ( 16例 ) ;2 5 % ( 2例 )vs 6 8% ( 8例 ) ,P <0 0 5 )明显下降。 结论 在活体供肾移植中 ,HALDN似乎优于LDN ,但尚需要前瞻性对照研究予以进一步证实。
Objective To compare the effects of hand-assisted laparoscopic surgery (HALDN) and Laparoscopic denervation (LDN) in living donor kidney transplantation and donor versus kidney transplant recipients. Methods The data of all LDN and HALDN cases in Mount Sinai Medical Center from October 1996 to February 2001 were retrospectively reviewed. LDN surgery began in October 1996, and in June 1999 switched to HALDN surgery. Results Compared with the LDN group, the operative time of HALDN group was significantly shorter (2 11 ± 7) min vs (257 ± 5) min, P 0 05, and the amount of bleeding during operation was significantly lower (12 2 ± 17) ml (286 ± 33) ml, P <0 05). The time of warm ischemia was significantly shorter (10 6 ± 6 vs 25 7 ± 8) s, P 0 05, The incidence of leakage and thrombosis (0% vs 13 7% (16 cases); 25% (2 cases) vs 6 8% (8 cases), P <0 05) decreased significantly. Conclusions HALDN appears to be superior to LDN in living donor kidney transplantation, but prospective, controlled studies are needed to confirm this.