Division of Gastrointestinal and Minimally Invasive Surgery, Carolinas Medical Center, 1000 Blythe Blvd, MEB #601, Charlotte, NC 28203, USA.
Surg Endosc. 2009 Oct;23(10):2327-31. doi: 10.1007/s00464-009-0330-9. Epub 2009 Mar 5.
Studies have shown donor and recipient outcomes to be equivalent for laparoscopic donor nephrectomy (LDN) and open donor nephrectomy. In the past, LDN has been avoided in the procurement of the right kidney or organs with multiple arteries. This study compares procurement of right and left kidneys as well as procurement of single- and multiple artery organs.
A review of all LDNs at a single institution between August 2000 and December 2007 was performed. The data included estimated blood loss (EBL), need for transfusion, operative time, warm ischemia time, length of hospital stay (LOS), and delayed graft function. Arterial supply was assessed using renal arteriogram or computed tomographic (CT) angiography. Outcomes for multiple versus single artery and left versus right LDN were compared. Student's t-test and chi-square test were used for statistical comparison.
A total of 230 LDNs were performed. Multiple arteries were present in 37 donors. The right kidney was procured from 36 donors. No significant difference in EBL, transfusions, operative time, or LOS was noted between multiple and single or right and left LDNs. Warm ischemia time was significantly longer for multiple arteries (mean, 83 s) than for single arteries (mean, 63 s; p = 0.007), and for right kidneys (mean, 86 s) than for left kidneys (mean, 62 s; p = 0.001). No significant difference in delayed graft function was seen in the comparison of multiple (21.6%) and single (11.4%) artery organs (p = 0.11) or of right (13.9%) and left (12.9%) kidneys (p = 0.79).
The presence of multiple arteries or the need to procure the right kidney does not affect the operative outcome of laparoscopic donor nephrectomy. Warm ischemia time may be greater for these groups, but this does not result in delayed allograft function. The laparoscopic approach should be the standard of care even when expansion of the donor pool includes organs with multiple arteries and procurement of the right kidney.
研究表明，腹腔镜供肾切取术（LDN）与开放性供肾切取术在供体和受者的结果方面是等效的。过去，LDN 一直避免用于获取右肾或有多支动脉的器官。本研究比较了获取右肾和左肾以及获取单支和多支动脉器官的情况。
对 2000 年 8 月至 2007 年 12 月在一家机构进行的所有 LDN 进行了回顾性研究。数据包括估计失血量（EBL）、输血需求、手术时间、热缺血时间、住院时间（LOS）和延迟移植物功能。采用肾动脉造影或 CT 血管造影评估动脉供应。比较了多支与单支动脉、左肾与右肾 LDN 的结果。采用学生 t 检验和卡方检验进行统计学比较。
共完成 230 例 LDN，37 例供者有多支动脉。36 例供者的右肾被切取。多支与单支或右肾与左肾 LDN 在 EBL、输血、手术时间或 LOS 方面无显著差异。多支动脉（平均 83 秒）的热缺血时间明显长于单支动脉（平均 63 秒；p=0.007），也明显长于右肾（平均 86 秒）与左肾（平均 62 秒；p=0.001）。多支（21.6%）和单支（11.4%）动脉器官（p=0.11）或右肾（13.9%）和左肾（12.9%）（p=0.79）之间的延迟移植物功能无显著差异。
多支动脉的存在或需要获取右肾不会影响腹腔镜供肾切取术的手术结果。这些组的热缺血时间可能会更长，但这不会导致移植物功能延迟。即使供肾来源扩大包括有多支动脉的器官和获取右肾，腹腔镜方法也应成为标准治疗方法。
