Satyapal K S, Kalideen J M, Singh B, Haffejee A A, Robbs J V
School of Basic and Applied Medical Sciences, University of Durban-Westville.
S Afr J Surg. 2003 Feb;41(1):24-6.
In addition to the superior graft survival afforded by live related transplantation, this option has assumed an important role in the management of endstage renal failure in centres confronted with a scarcity of cadaveric kidneys. In pursuing this option, it is imperative that the donor has minimal morbidity. An ongoing dilemma is which side the kidney should be harvested from. This study reviews the anatomical basis for selecting the left kidney and the impact on outcome for patient and donor. A database comprising cadaveric and clinical subsets was analysed. The total sample size analysed was 1 244 kidney pairs (305 cadaveric; 939 clinical (61 live related left kidney transplants harvested by the extraperitoneal approach)).
Additional renal arteries (ARAs): Right first, second = 18.6%, 4.7%; left first, second = 27.6%, 4.4%. Additional renal veins (ARV): Right first, second = 26%, 3.3%; left first only = 2.6%. Length of renal vein (cm): Right 2.4 +/- 0.7, left 5.9 +/- 1.5. Other venous variations encountered were on the left side only (renal collar 0.3%, retro-aortic vein 0.5%). In the live related transplant series 24.6% ARAs were encountered (first 19.7%, second 4.9%). The postoperative course and outcome of both donor and recipient were not associated with increased morbidity. While greater length of the left renal vein (LRV) afforded easier technical manipulation, it is interesting to note that its length is shorter than that reported in the literature. ARVs are infrequent on the left and when encountered the smaller calibre vessel may be ligated with impunity due to rich intrarenal anastomosis. In selecting the donor kidney the surgeon has to balance the prospect of fewer ARAs on the right against the benefit of a longer LRV. The solution to this dilemma can only arise from a randomised clinical study. In our practice, consistent use of the left kidney has not affected clinical outcome.
除了活体亲属移植能带来更好的移植物存活率外，在面临尸体肾短缺的中心，这种移植方式在终末期肾衰竭的治疗中也发挥了重要作用。在采用这种方式时，供体的发病率必须降至最低。目前存在的一个两难问题是应该从哪一侧摘取肾脏。本研究回顾了选择左肾的解剖学依据以及对患者和供体预后的影响。分析了一个包含尸体肾和临床病例子集的数据库。分析的总样本量为1244对肾脏（305对尸体肾；939例临床病例（61例通过腹膜外途径摘取的活体亲属左肾移植））。
额外肾动脉（ARAs）：右侧第一、二条分别为18.6%、4.7%；左侧第一、二条分别为27.6%、4.4%。额外肾静脉（ARV）：右侧第一、二条分别为26%、3.3%；左侧仅第一条为2.6%。肾静脉长度（厘米）：右侧2.4±0.7，左侧5.9±1.5。其他静脉变异仅在左侧出现（肾环0.3%，主动脉后静脉0.5%）。在活体亲属移植系列中，发现24.6%的额外肾动脉（第一条19.7%，第二条4.9%）。供体和受体的术后病程及预后与发病率增加无关。虽然左肾静脉（LRV）较长便于技术操作，但有趣的是其长度比文献报道的要短。左侧的额外肾静脉很少见，当遇到时，由于丰富的肾内吻合，较小口径的血管可以安全结扎。在选择供体肾时，外科医生必须在右侧额外肾动脉较少的可能性与较长左肾静脉的益处之间进行权衡。这个两难问题的解决方案只能来自随机临床研究。在我们的实践中，持续使用左肾并未影响临床结果。
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