Hand-Assisted Laparoscopic Live Donor Nephrectomy Versus the Conventional Open Approach

比較手輔助腹腔鏡活體取腎與傳統術式之差異

陳卷書(Chuan-Shu Chen) ； 蘇重光(Chung-Kuang Su) ； 裘坤元(Kun-Yuan Chiu) ； 歐宴泉(Yen-Chuan Ou) ； 賀昊中(Hao-Chung Ho) ； 程千里(Chen-Li Cheng) ； 陳文銘(Wen-Ming Chen) ； 楊啟瑞(Chi-Rei Yang) ； Ming-Kuen Lai

《Formosan Journal of Surgery》 36卷6期 (2003/12) Pp. 268-273

摘要

近年來，手輔助腹腔鏡活體取腎是一種很被熱衷的手術，在台灣有很多家醫院在做這項手術。有許多文章報告顯示，此項手術較傳統術式帶來許多好處，包括：縮短住院天數、減少術中出血、減少術後疼痛和恢復快。本院自民國 91 年起開始，做手輔助腹腔鏡活體取腎至今，共完成 4 例。本篇文章將此 4 例與本院過去 4 年所做傳統活體取腎手術之病例做比較，結果與其他報告一樣：手輔助腹腔鏡活體取腎確實明顯縮短住院天數，減少術中出血和恢復快。比較手輔助腹腔鏡活體取腎與傳統術式的受腎者，術後一個月內腎功能恢復無顯著差異。故手輔助腹腔鏡活體取腎是一個值得推廣代替傳統手術的方法。

並列摘要

Objective: Hand-assisted laparoscopic live donor nephrectomy is an emerging technique in the field of renal transplantation. We report our initial experience in applying this technique and make a comparison with open live donor nephrectomy. Methods: We retrospectively reviewed the medical records of 15 patients receiving live donor nephrectomy from Feb 1998 to Dec 2002. Among them, 4 patients received hand-assisted live donor nephrectomy and the other 11 patients received a conventional open live donor nephrectomy.
Results: In the hand-assisted laparoscopic group and open group, the mean operation time was 322 minutes and 216 minutes (p＜0.0002), mean intra-operative blood loss was 87 ml and 290 ml (p=0.00l), mean postoperative hospital stay was 4.7 days and 7.7 days (p0.0001), and mean warm ischemic time was 248 seconds and 95 seconds (p＜0.001) respectively. The donor postoperative oral intake, preoperative serum creatinine, postoperative serum creatinine and recipient postoperative initial graft function in the two groups were not statistically different.
Conclusions: Although taking more operation time, hand-assisted laparoscopic live donor nephrectomy is a safe procedure and it has definite advantages for donors, including less intraoperative blood loss, shorter length of postoperative hospital stay and early convalescence.

並列關鍵字

hand-assisted ； laparoscopy ； donor nephrectomy