생체 신이식에서 신적출술 485예: 수술 술기와 안전성

Abstract

Purpose: Living donors are more frequently used to treat end stage renal disease in Korea. We investigated postoperative complications and recent trends of the living donor nephrectomy. Methods: From November 1982 to December 2001, we performed consecutive 485 cases of living donor nephrectomy. Among them, 445 cases were performed through extra-retroperitoneal flank incision without rib resection and 40 cases through thoracoabdominal or supracostal incision with 11 th or 12 th rib resection. All cases were analyzed by reviewing medical records. Results: Total 50 (10.3%) patients had complications after donor nephrectomy. Complication rate was significantly higher in rib resected group. In 40 cases of rib resected group, there were 4 cases of pneumothorax, 1 case of intraoperative transfusion, 2 cases of retroperitoneal hematoma, 3 cases of wound infection, 2 cases of paralytic ileus, 1 case of atelectasis and 1 case of UTI. In 445 cases without rib resection, there were 2 cases of intraoperative transfusion, 3 cases of retroperitoneal hematoma, 15 cases of wound infection, 2 cases of incisional hernia, 1 case of paralytic ileus, 1 case of atelectasis and 5 cases of UTI. Total 5 cases were readmitted with wound infection. But no one had expired due to intraoperative or immediate postoperative complications. Average hospital stay was 9.4 days, and it was 8.2 days In recent 7 years. Mean operative time was 160 minutes. Mean time to regular diet was 2.6 days. Conclusion: Kidney donors had a few complications and low operative risk, so living donor nephrectomy can be safely recommended to kidney donors. The patients, who had been nephrectomised by extra-retroperitoneal flank approach without rib resection, had no major complications, recovered much faster and hospitalized much shorter than those of thoracoabdominal or supracostal incision with rib resection. We recommend extra-retroperitoneal flank incision without rib resection in living donor nephrectomy.