超小切口肾移植与传统Gibson切口肾移植的比较

Comparison between a novel Super-Minimal Incision Kidney Transplantation and conventional Gibson incision kidney transplantation

目的比较超小切口肾移植（Super-Minimal Incision Kidney Transplantation，SMIKT）与传统Gibson切口肾移植（conventional incision kidney transplantation，CIKT）手术方式的安全性和有效性。方法对40例SMIKT受者的临床资料进行回顾性分析，并与同期56例施行CIKT受者的临床资料进行对比，分析各组手术时间、术后疼痛评分、镇痛药物使用及术后1个月肾功能及切口瘢痕评分。结果SMIKT组手术时间为（100±10）min，CIKT组为（127.5±34.3）min（P＝0.044）；SMIKT组手术切口长度明显小于CIKT组[（5.2±0.2）cm与（13.0±2.0）cm，P〈0.001]。SMIKT组术后第1天疼痛评分明显小于CIKT组（1.31±1.15与4.02±1.83，P＝0.004），但是第2天开始两组疼痛评分没有差异（第2天：2.33±2.08与2.50±1.73，P＝0.08；第3天：2.01±1.07与2.33±1.61，P＝0.31）；SIMKT组镇痛药物使用量也明显低于CIKT组（3.13±1.74与11.69±2.89，P＝0.002）。两组在术后1个月肾功能比较，差异无统计学意义；术后1个月温哥华瘢痕评分显示，SMIKT组评分明显低于CIKT组（6.50±0.58与8.67±0.58，P＝0.004）。结论与传统Gibson切口肾移植比较，SMIKT是一种安全的手术方式，能够明显缩短手术时间，减少术后疼痛及镇痛药物使用，有更好的短期美容效果。

Objective To evaluate the safety of super-minimal incision kidney transplantation （SMIKT）. Methods We included the clinical data and outcomes of 4（I cases of SMIKT and 56 cases of conventional Gibson incision kidney transplantation （CIKT）, and compared the operation time, post operative pain, analgesic requirements, l-month renal function and 1 month Vancouver scar scale between the two groups. Results As compared with CIKT, operation time was significantly shortened （100 111 versus 127. 5± 34. 3 min, P =0.044）, incision length was significantly shortened （5.2 ± 0. 2 versus 13.0±2. 0 cm, P〈0. 001 ）, and post-operative pain at day 1 was significantly reduced in SMIKT （1.3±1.15 versus 4. 02 ± l. 83, P = 0.004）. However, there was no significant difference in post operative pain at day 2 and day 3 between CIKT and SMIKT. SMIKT required less analgesic medications than CIKT （3. 13 ± 1.74 versus 11.69 ±2. 89, P=0. 002）. No significant difference in 1- month renal function was observed between two groups. SMIKT had fewer Vancouver scar scale score than CIKT （6. 50 ±0. 58 versus 8.67 ±0. 58, P = 1）. （11/4）. Conclusion SMIKT is a safe novel surgery, which can significantly reduce operation time, post operative pain, had fewer analgesic requirements and better 1-month cosmetic effect.