Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA.
Am J Transplant. 2011 May;11(5):1031-4. doi: 10.1111/j.1600-6143.2011.03495.x.
The laparoscopic approach to donor nephrectomy is becoming increasingly common. While it is felt that the recovery from laparoscopic nephrectomy is quicker and less painful, a number of complications have been reported. A rarely reported on complication in the literature with significant morbidity is ipsilateral orchalgia. From 1998 to 2008, 257 hand-assisted laparoscopic donor nephrectomies were performed at our institution. Eight of 129 (6.2%) men complained of de novo ipsilateral orchalgia postoperatively. The average duration of pain was 402 days. Patients reported significant morbidity related to this complication. None, however, required further treatment. Three patients reported that they would reconsider organ donation as a result of testicular pain. Our technique originally included dissection and ligation of the gonadal vein en bloc with the ureter at the level of the left common iliac artery. Since recognizing this complication, we have adopted a gonadal vein sparing approach so as not to disturb the vessel below its point of ligation at the renal vein. To date, 50 patients have undergone the modified technique without experiencing orchalgia. In conclusion, ipsilateral testicular pan is a relatively frequent complication of laparoscopic donor nephrectomy and may be a source of significant morbidity. Using a modified surgical technique, this complication can be reduced or eradicated.
腹腔镜供肾切除术越来越常见。虽然腹腔镜肾切除术的恢复更快，疼痛更少，但也有一些并发症的报道。在文献中，有一种罕见但发病率较高的并发症是同侧睾丸痛。1998 年至 2008 年，我们机构共进行了 257 例手助腹腔镜供肾切除术。129 例男性中有 8 例（6.2%）术后出现新发性同侧睾丸痛。疼痛的平均持续时间为 402 天。患者报告了与该并发症相关的显著发病率。然而，没有患者需要进一步治疗。有 3 名患者报告说，由于睾丸疼痛，他们会重新考虑器官捐献。我们的技术最初包括在左髂总动脉水平将性腺静脉与输尿管整块解剖和结扎。自从认识到这种并发症以来，我们采用了保留性腺静脉的方法，以免在肾静脉结扎点以下干扰血管。迄今为止，50 例患者采用改良技术，无睾丸痛发生。总之，腹腔镜供肾切除术术后同侧睾丸痛是一种相对常见的并发症，可能导致显著的发病率。采用改良手术技术可以减少或消除这种并发症。
