Breda Alberto, Bui Matthew H, Liao Joseph C, Gritsch H Albin, Schulam Peter G
Department of Urology, David Geffen School of Medicine at University of California-Los Angeles, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA.
J Urol. 2006 Sep;176(3):1065-8. doi: 10.1016/j.juro.2006.04.079.
Previous reports of laparoscopic donor nephrectomy have suggested that preservation of the gonadal vein with the specimen is important for preventing ureteral strictures. To test this hypothesis we examined our series of patients for the incidence of ureteral strictures when the gonadal vein was not preserved with the specimen during laparoscopic donor nephrectomy.
We reviewed the records of 300 consecutive patients at our institution who underwent laparoscopic donor nephrectomy between 2000 and 2005. Mean donor age was 36.7 years (range 18 to 68) in the 167 female and 133 male donors. Mean recipient age was 38.4 years. Average followup was 2 years. During ureteral dissection the gonadal vein was transected just distal to the renal vein and left in situ. The ureter was dissected and transected at the level of the common iliac vessels. Indwelling ureteral stents were used for all recipient ureteral reimplantations and left in place for 1 month. In the postoperative period transplant recipients were followed biweekly for serum creatinine function during month 1 and monthly thereafter. All patients with increased creatinine (greater than 1.3 mg/dl) or an increasing trend were evaluated with transplant renal ultrasound. Clinically significant ureteral stricture was defined as persistent hydronephrosis resulting in impaired renal function and the need for percutaneous nephrostomy tube placement or ureteroscopic management.
After laparoscopic living donor transplantation without gonadal vein preservation we found no incidence of clinically significant ureteral stricture.
Gonadal vein preservation with the specimen during laparoscopic donor nephrectomy is not necessary. Preservation of the periureteral blood supply is sufficient to prevent ureteral strictures.
先前关于腹腔镜供肾切除术的报道表明，在标本中保留性腺静脉对于预防输尿管狭窄很重要。为了验证这一假设，我们对一系列在腹腔镜供肾切除术中未将性腺静脉与标本一起保留的患者进行了输尿管狭窄发生率的检查。
我们回顾了2000年至2005年间在我院连续接受腹腔镜供肾切除术的300例患者的记录。167名女性供体和133名男性供体的平均供体年龄为36.7岁（范围18至68岁）。平均受体年龄为38.4岁。平均随访时间为2年。在输尿管解剖过程中，性腺静脉在肾静脉远侧被切断并留在原位。输尿管在髂总血管水平处被解剖并切断。所有受体输尿管再植均使用留置输尿管支架，并留置1个月。术后第1个月每两周对移植受体进行血清肌酐功能随访，此后每月随访一次。所有肌酐升高（大于1.3mg/dl）或呈上升趋势的患者均接受移植肾超声检查。临床显著的输尿管狭窄定义为持续性肾积水导致肾功能受损，以及需要放置经皮肾造瘘管或进行输尿管镜处理。
在未保留性腺静脉的腹腔镜活体供肾移植术后，我们未发现临床显著输尿管狭窄的发生。
在腹腔镜供肾切除术中，无需将性腺静脉与标本一起保留。保留输尿管周围血供足以预防输尿管狭窄。
