Simforoosh Nasser, Aminsharifi Alireza, Tabibi Ali, Fattahi Mohammadreza, Mahmoodi Hossein, Tavakoli Mahmmoud
Urology Nephrology Research Center, Shaheed Labbafinejad Hospital, Shaheed Beheshti University of Medical Sciences, Tehran, Iran.
BJU Int. 2007 Dec;100(6):1347-50. doi: 10.1111/j.1464-410X.2007.07134.x. Epub 2007 Sep 10.
To report a novel approach to overcome the problems associated with a short right renal vein harvested by clipping the vein during right laparoscopic donor nephrectomy (RLDN).
This prospective study included 32 donors and their recipients; all donors had transperitoneal RLDN. The right renal artery and vein were ligated by Hem-o-lok and titanium clips, which resulted in a very short renal vein (<1.5 cm). When the kidney was positioned inverted in the recipient, the renal vein was placed posteriorly, adjacent to the external iliac vein, making a safe and simple venous anastomosis possible.
All RLDN were completed with no conversion or re-operation. The mean (range) warm ischaemia time was 9.59 (3-17) min and there was no malfunction of the vascular clips on the major vessels. After a mean follow-up of 14 months the recipient survival rate was 97%. Graft function was excellent, with a mean (sd) serum creatinine level of 1.35 (0.31) mg/dL at 3 months after surgery, and there was no renal artery or vein thrombosis in any of the grafts. There were two ureteric complications (6%), i.e. one ureterocutaneous fistula resolved by secondary ureteroureterostomy, and one stricture at the site of ureteric anastomosis, which was managed by ureteroneocystostomy.
The right renal vein obtained by LDN, after clipping the renal vein, is quite short, but by placing the kidney upside-down in the right iliac fossa transplantation is possible with no increased incidence of vascular thrombosis. This simple modification might obviate the need for removing a patch from the inferior vena cava, which is a challenging procedure for laparoscopic surgeons during RLDN.
报告一种新方法，以克服在右侧腹腔镜供肾切除术（RLDN）中通过夹闭静脉获取的右肾静脉过短所带来的问题。
这项前瞻性研究纳入了32名供体及其受体；所有供体均接受经腹RLDN。右肾动脉和静脉用Hem-o-lok和钛夹结扎，导致肾静脉非常短（<1.5厘米）。当将肾脏倒置放置于受体体内时，肾静脉位于后方，与髂外静脉相邻，从而使得安全且简单的静脉吻合成为可能。
所有RLDN均顺利完成，无中转或再次手术情况。平均（范围）热缺血时间为9.59（3 - 17）分钟，主要血管上的血管夹无故障。平均随访14个月后，受体生存率为97%。移植肾功能良好，术后3个月时血清肌酐水平平均（标准差）为1.35（0.31）mg/dL，且所有移植肾均未发生肾动脉或静脉血栓形成。有2例输尿管并发症（6%），即1例输尿管皮肤瘘经二次输尿管输尿管吻合术治愈，1例输尿管吻合口处狭窄，经输尿管膀胱再植术处理。
在RLDN中夹闭肾静脉后获取的右肾静脉相当短，但通过将肾脏倒置放入右髂窝，仍可进行移植，且血管血栓形成发生率未增加。这种简单改进可能无需从下腔静脉取下补片，而这对腹腔镜外科医生在RLDN中是一项具有挑战性的操作。
