腹膜后腹腔镜活体供肾肾切除术。初步结果。

Hoznek A, Olsson L E, Salomon L, Saint F, Cicco A, Chopin D, Abbou C C

Service d'Urologie, Centre Hospitalier Universitaire Henri Mondor, Créteil, France.

Eur Urol. 2001 Dec;40(6):614-8. doi: 10.1159/000049846.

PURPOSE

Living-donor nephrectomy is performed via a standard flank approach during open surgery in contrast to laparoscopy where kidneys are procured transperitoneally. Being more familiar with retroperitoneal laparoscopy for the surgery of the upper urinary tract, we investigated the feasibility of live donor nephrectomy by this approach.

MATERIAL AND METHODS

We performed laparoscopic retroperitoneal left-sided nephrectomy in 3 living donors. The patients were placed in lumbotomy position. The retroperitoneal space was developed with blunt finger dissection, through a 2-cm mini-lumbotomy under the 12th rib in the posterior axillary line. 5 trocars were inserted. After primary access to the renal artery and vein, these were dissected to their junctions with the aorta and inferior vena cava, respectively, before freeing the kidney of its perinephric attachments. The kidney was delivered manually, through the slightly enlarged initial subcostal incision.

RESULTS

The average duration of surgery was 83 min; warm ischemia time less than 5 min. Average blood loss was 120 cm(3). Donors did not present any postoperative morbidity and were discharged after an average of 2.3 days. Mean analgesic requirement was 5 mg morphine sulphate equivalent (0-15). Average convalescence was 13.3 days (10-18). All 3 kidneys harvested laparoscopically had immediate function with urine production after graft revascularization; serum creatinine levels returned to normal within 1 week. The first patient presented ureteral stenosis 2 months after surgery. He underwent ureteropyeloplasty using his native ureter.

CONCLUSIONS

Laparoscopic living-related-donor nephrectomy become a new standard for organ harvesting. Our data suggest that retroperitoneal laparoscopic donor nephrectomy may represent a reasonable option in centers in which more extensive experience has been accumulated with retroperitoneal than with transperitoneal laparoscopy for the surgery of the upper urinary tract.

目的

与经腹腔获取肾脏的腹腔镜手术不同，活体供肾肾切除术在开放手术中通过标准的侧腹入路进行。由于我们更熟悉用于上尿路手术的腹膜后腹腔镜检查，因此我们研究了通过这种方法进行活体供肾肾切除术的可行性。

材料与方法

我们对3名活体供者进行了腹腔镜腹膜后左侧肾切除术。患者取侧卧位。通过在腋后线第12肋下做一个2厘米的小侧腹切口，用手指钝性分离来建立腹膜后间隙。插入5个套管针。在初步暴露肾动脉和肾静脉后，将它们分别解剖至与主动脉和下腔静脉的连接处，然后游离肾脏的肾周附着物。通过稍微扩大最初的肋下切口手动取出肾脏。

结果

平均手术时间为83分钟；热缺血时间少于5分钟。平均失血量为120立方厘米。供者术后未出现任何并发症，平均2.3天后出院。平均镇痛需求量为5毫克硫酸吗啡当量（0 - 15）。平均康复时间为13.3天（10 - 18天）。所有3个经腹腔镜获取的肾脏在移植血管再通后立即发挥功能并产生尿液；血清肌酐水平在1周内恢复正常。第一例患者术后2个月出现输尿管狭窄。他接受了使用自身输尿管的输尿管肾盂成形术。