Fuller T Florian, Deger Serdar, Büchler Annette, Roigas Jan, Schönberger Bernd, Schnorr Dietmar, Tüllmann Max, Loening Stefan A, Giessing Markus
Department of Urology, Charité Universitaetsmedizin Berlin Campus Mitte, Berlin, Germany.
Eur Urol. 2006 Sep;50(3):535-40; discussion 540-1. doi: 10.1016/j.eururo.2006.03.025. Epub 2006 Mar 29.
We report on ureteral and surgical complications in our first 110 consecutive recipients of kidneys procured with laparoscopic living donor nephrectomy (LLDN).
The records of all living donor transplants with LLDN performed between February 1999 and December 2004, including 10 pediatric transplants, were reviewed retrospectively. Three urologists performed LLDN using a pure laparoscopic non-hand-assisted transperitoneal technique. Kidney transplantation was performed in a standard fashion. For ureteroneocystostomy, the intravesical Politano-Leadbetter (P-L) technique was used.
Two-year patient and graft survival was 99% and 98%, respectively. Serum creatinine at 12 months was 1.36+/-0.1mg/dl in adult and 0.99+/-0.23 mg/dl in pediatric recipients. Nineteen right donor kidneys were transplanted into adult recipients. Surgical complications included three symptomatic lymphoceles, one peritransplant haematoma and one kinking of a lower pole artery. All five (4.5%) ureteral complications occurred in adult recipients with a mean age of 33.2+/-2.8 years. The incidence of ureteral complications was not clustered around the early phase of our LLDN experience. Of the three (2.7%) patients diagnosed with ureteral obstruction, two required ureteral reimplantation, and one was managed conservatively. Another two patients (1.8%) with a urinary leak received a double J stent and a cystostomy catheter for 3 and 5 months, respectively. Of the five patients with a ureteral complication, three had received a donor kidney with more than one renal artery.
LLDN combined with the intravesical (P-L) ureteral implantation technique provides excellent graft outcomes with low recipient morbidity. Renal artery multiplicity may increase the risk of ureteral complications.
我们报告了连续110例接受腹腔镜活体供肾肾切除术（LLDN）获取的肾脏移植受者的输尿管及手术并发症情况。
回顾性分析1999年2月至2004年12月期间所有采用LLDN进行的活体供肾移植记录，其中包括10例儿科移植病例。3名泌尿外科医生采用单纯腹腔镜非手辅助经腹技术进行LLDN。肾移植按标准方式进行。输尿管膀胱吻合采用膀胱内Politano-Leadbetter（P-L）技术。
患者和移植物的2年生存率分别为99%和98%。成人受者术后12个月时血清肌酐为1.36±0.1mg/dl，儿科受者为0.99±0.23mg/dl。19个右侧供肾移植给成人受者。手术并发症包括3例有症状的淋巴囊肿、1例移植肾周围血肿和1例下极动脉扭结。所有5例（4.5%）输尿管并发症均发生在平均年龄为33.2±2.8岁的成人受者中。输尿管并发症的发生率在我们LLDN经验的早期阶段并未集中出现。在3例（2.7%）被诊断为输尿管梗阻的患者中，2例需要进行输尿管再植，1例采用保守治疗。另外2例（1.8%）发生尿漏的患者分别接受了双J支架和膀胱造瘘导管治疗3个月和5个月。在5例有输尿管并发症的患者中，3例接受的供肾有不止一条肾动脉。
LLDN联合膀胱内（P-L）输尿管植入技术可提供良好的移植物结局，且受者发病率较低。肾动脉多支可能增加输尿管并发症的风险。
