Hazebroek E J, de Bruin R W F, Bouvy N D, van Duikeren S, Bonthuis F, Marquet R L, Bajema I M, Hayes D P, IJzermans J N M, Bonjer H J
Department of Surgery, University Hospital Rotterdam-Dijkzigt, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands.
Surg Endosc. 2002 Feb;16(2):245-51. doi: 10.1007/s00464-001-8169-8. Epub 2001 Nov 16.
Laparoscopic donor nephrectomy has the potential to increase the number of living kidney donations by reducing donor morbidity. However, studies have shown that raised intraabdominal pressure can result in transient renal dysfunction. Therefore, laparoscopically procured kidneys might be at higher risk for suffering a period of ischemia during pneumoperitoneum. The objective of this study was to investigate the short-term impact of pneumoperitoneum used for laparoscopic donor nephrectomy on renal function and histomorphology in donor and recipient.
EXPERIMENT 1: KIDNEY DONOR: Initially, 36 brown Norway (BN) rats were randomized for three procedures: 2 h of carbon dioxide (CO2) insufflation (8 mmHg), 2 h of helium insufflation (8 mmHg), and 2 h of gasless technique (0 mmHg). After this, a unilateral nephrectomy was performed in all the animals. EXPERIMENT 2: RECIPIENT: Subsequently, 36 donor BN rats were subjected to a similar insufflation protocol, but after nephrectomy, a syngeneic kidney transplantation (BN-BN) was performed. Urine and blood samples were collected on postoperative days 1, 3, 7, and 14 for determination of renal function. Subsequently, donor and recipient kidneys were removed for histomorphologic and immunohistochemical analysis.
In both donors and recipients, no significant changes in serum creatinine, proteinuria, or glomular filtration were detected between the CO2, the helium, and the gasless control groups. In both experiments, histologic analysis of Kidney specimens did not show any deleterious effects from abdominal gas insufflation. Although kidney grafts exposed to CO2 showed significantly higher numbers of CD45+ leukocytes 3 days after transplantation, immunohistochemical analysis did not show significant differences in number of infiltrating cells (CD4, CD8, ED1, OX6, OX62) between the two insufflation groups and the gasless control subjects.
Abdominal gas insufflation does not have an adverse effect on the renal function of the kidney donor 1 week after laparoscopic donor nephrectomy. No differences in renal function or histomorphology were detected between syngeneic kidney grafts exposed to pneumoperitoneum and gasless control subjects.
腹腔镜供肾切除术有可能通过降低供体发病率来增加活体肾捐献的数量。然而，研究表明，腹内压升高可导致短暂性肾功能障碍。因此，经腹腔镜获取的肾脏在气腹期间可能面临更高的缺血风险。本研究的目的是调查用于腹腔镜供肾切除术的气腹对供体和受体肾功能及组织形态学的短期影响。
实验1：肾脏供体：最初，将36只棕色挪威（BN）大鼠随机分为三组进行三种操作：二氧化碳（CO₂）气腹2小时（8 mmHg）、氦气气腹2小时（8 mmHg）和无气技术2小时（0 mmHg）。在此之后，对所有动物进行单侧肾切除术。实验2：受体：随后，36只供体BN大鼠接受类似的气腹方案，但在肾切除术后进行同基因肾移植（BN-BN）。在术后第1、3、7和14天收集尿液和血液样本以测定肾功能。随后，取出供体和受体的肾脏进行组织形态学和免疫组织化学分析。
在供体和受体中，CO₂组、氦气组和无气对照组之间的血清肌酐、蛋白尿或肾小球滤过率均未检测到显著变化。在两个实验中，肾脏标本的组织学分析均未显示腹内充气有任何有害影响。尽管暴露于CO₂的肾移植在移植后3天显示CD45⁺白细胞数量显著增加，但免疫组织化学分析显示，两个气腹组与无气对照组之间的浸润细胞（CD4、CD8、ED1、OX6、OX62）数量没有显著差异。
腹腔镜供肾切除术后1周，腹内充气对肾脏供体的肾功能没有不利影响。暴露于气腹的同基因肾移植与无气对照组在肾功能或组织形态学上未检测到差异。
