中华泌尿外科杂志
中華泌尿外科雜誌
중화비뇨외과잡지
CHINESE JOURNAL OF UROLOGY
2008年
9期
598-602
,共5页
高振利%赵俊杰%孙德康%柳东夫%王琳%杨典东%姜仁慧%王建明%石磊%万峰春%方艳丽%王科
高振利%趙俊傑%孫德康%柳東伕%王琳%楊典東%薑仁慧%王建明%石磊%萬峰春%方豔麗%王科
고진리%조준걸%손덕강%류동부%왕림%양전동%강인혜%왕건명%석뢰%만봉춘%방염려%왕과
腹腔镜%肾移植%活体供者%随访
腹腔鏡%腎移植%活體供者%隨訪
복강경%신이식%활체공자%수방
Laparoscopes%Kidney transplantation%Living donors%Follow-up
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.
目的 比較腹腔鏡活體取腎(LDN)與開放手術活體取腎(ODN)的手術安全性及供者術後1年腎功能及血壓狀況. 方法LDN和ODN各30例,比較2組手術時間、熱缺血時間、術中失血量、術後開始進食時間及術後開始下床活動時間,併根據改良Clavien分級繫統統計2組圍手術期併髮癥情況.對2組供者術前及術後第1天、1週、3、6箇月、1年的血肌酐、血壓、24 h尿蛋白定量水平和術前及術後6箇月、1年時的腎小毬濾過率(GFR)值進行統計比較. 結果 LDN組和ODN組手術時間分彆為(98.65±13.6)、(96.3±19.5)min,熱缺血時間為(90.6±15.1)、(86.4±12.3)s,2組術中失血量為(105.2±34.8)、(206.35±126.4)ml(P<0.01).術後開始進食及開始下床活動時間LDN組分彆為(28.55±2.9)、(25.85±3.8)h,ODN組分彆為(38.6±3.3)、(36.5±5.3)h(P值均<0.01).LDN和ODN組圍手術期併髮癥總髮生率分彆為6.6%(2/30)和23.3%(7/30).術後第1天、1週、3箇月、6箇月、1年時血肌酐水平LDN組為(109.1±7.5)、(105.4士9.5)、(96.6±10.7)、 (89.4±11.5)、(91.6±9.3)μmol/L,ODN組為(107.3±9.6)、(103.3±8.4)、(95.4±9.1)、(90.5±13.6)、(90.35±11.7)μmol/L.2組術後6箇月時平均GFR值分彆為64.7、65.8 ml/min,術後1年時為65.9、67.5 ml/min,與術前相比差異均有統計學意義(P<0.05),術後1年與術後6箇月時相比及2組問同期比較差異均無統計學意義(P>0.05).術後1年內2組平均24 h尿蛋白定量水平及血壓與術前相比及2組間同期比較差異均無統計學意義(P>0.05). 結論 LDN具有創傷小,齣血少、恢複快的優點,手術安全性與ODN相噹,術後1年內對供者的腎功能及血壓無明顯不良影響.
목적 비교복강경활체취신(LDN)여개방수술활체취신(ODN)적수술안전성급공자술후1년신공능급혈압상황. 방법LDN화ODN각30례,비교2조수술시간、열결혈시간、술중실혈량、술후개시진식시간급술후개시하상활동시간,병근거개량Clavien분급계통통계2조위수술기병발증정황.대2조공자술전급술후제1천、1주、3、6개월、1년적혈기항、혈압、24 h뇨단백정량수평화술전급술후6개월、1년시적신소구려과솔(GFR)치진행통계비교. 결과 LDN조화ODN조수술시간분별위(98.65±13.6)、(96.3±19.5)min,열결혈시간위(90.6±15.1)、(86.4±12.3)s,2조술중실혈량위(105.2±34.8)、(206.35±126.4)ml(P<0.01).술후개시진식급개시하상활동시간LDN조분별위(28.55±2.9)、(25.85±3.8)h,ODN조분별위(38.6±3.3)、(36.5±5.3)h(P치균<0.01).LDN화ODN조위수술기병발증총발생솔분별위6.6%(2/30)화23.3%(7/30).술후제1천、1주、3개월、6개월、1년시혈기항수평LDN조위(109.1±7.5)、(105.4사9.5)、(96.6±10.7)、 (89.4±11.5)、(91.6±9.3)μmol/L,ODN조위(107.3±9.6)、(103.3±8.4)、(95.4±9.1)、(90.5±13.6)、(90.35±11.7)μmol/L.2조술후6개월시평균GFR치분별위64.7、65.8 ml/min,술후1년시위65.9、67.5 ml/min,여술전상비차이균유통계학의의(P<0.05),술후1년여술후6개월시상비급2조문동기비교차이균무통계학의의(P>0.05).술후1년내2조평균24 h뇨단백정량수평급혈압여술전상비급2조간동기비교차이균무통계학의의(P>0.05). 결론 LDN구유창상소,출혈소、회복쾌적우점,수술안전성여ODN상당,술후1년내대공자적신공능급혈압무명현불량영향.
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.
