Kay Mark D, Brook Nicholas, Kaushik Monika, Harper Simon J F, Bagul Atul, Nicholson Michael L
University Hospitals of Leicester, Cardiovascular Sciences and Transplantation, Leicester, UK.
BJU Int. 2006 Oct;98(4):843-4. doi: 10.1111/j.1464-410X.2006.06429.x.
To compare the anatomy and function of right and left kidneys retrieved by laparoscopic live donor nephrectomy (LDN).
In all, 84 transperitoneal LDNs were performed, 66 left and 18 right. Two different right-sided LDN techniques were used: initially, the inferior vena cava (IVC) was controlled with a Satinsky clamp introduced through a 6-8 cm right upper quadrant incision, through which the kidney was also removed (six patients). Subsequently, the IVC was completely mobilized by laparoscopic retrocaval dissection (in 12 patients), allowing the use of a linear stapler-cutter, including the caval ostium with the renal vein. The kidney was then removed through a short Pfannenstiel incision.
Left kidneys had longer renal veins (38 vs 27 mm; P < 0.05), but there were no differences in arterial length (32 vs 31 mm). Three right kidneys required back-table renal vein lengthening. The operative duration was shorter for right-sided LDNs (132 vs 182 min; P < 0.05). The serum creatinine level at 3 months was 131 vs 134 mmol/L for right and left kidneys, respectively.
Despite faster surgery suggesting that the right LDN is technically easier, there is a greater need for back-table reconstruction of the renal vein. The functional results of right and left kidneys are equivalent.
比较经腹腔镜活体供肾肾切除术（LDN）获取的右肾和左肾的解剖结构及功能。
共进行了84例经腹LDN手术，其中66例为左肾切除，18例为右肾切除。采用了两种不同的右侧LDN技术：最初，通过右上腹6 - 8厘米切口置入Satinsky钳控制下腔静脉（IVC），并经此切口切除肾脏（6例患者）。随后，通过腹腔镜下腔静脉后分离术完全游离下腔静脉（12例患者），从而能够使用线性切割吻合器，包括切断肾静脉开口处。然后通过短Pfannenstiel切口切除肾脏。
左肾肾静脉较长（38毫米对27毫米；P < 0.05），但动脉长度无差异（32毫米对31毫米）。3例右肾需要在体外延长肾静脉。右侧LDN的手术时间较短（132分钟对182分钟；P < 0.05）。术后3个月时，右肾和左肾的血清肌酐水平分别为131和134微摩尔/升。
尽管手术速度更快表明右侧LDN在技术上更容易，但对肾静脉进行体外重建的需求更大。右肾和左肾的功能结果相当。
