Incidence of ureteral strictures after laparoscopic donor nephrectomy
Incidence of ureteral strictures after laparoscopic donor nephrectomy
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DOI：
10.1016/j.juro.2006.04.079
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发表时间：
2006-09-01
影响因子：
6.6
通讯作者：
Schulam, Peter G.
中科院分区：
文献类型：
--
作者：
Breda, Alberto;Bui, Matthew H.;Schulam, Peter G.
目的：以往关于腹腔镜供肾切除术的报道表明，保存性腺静脉标本对于预防输尿管狭窄很重要。为了验证这一假设，我们检查了在腹腔镜供肾切除术中当性腺静脉未随标本保存时输尿管狭窄的发生率。材料和方法：我们回顾了我院2000年至2005年间300例连续行腹腔镜供体肾切除术的患者的记录。167名女性和133名男性献血者的平均年龄为36.7岁（18至68岁）。平均年龄为38.4岁。平均随访时间为2年。在输尿管清扫术中，生殖腺静脉在肾静脉远端处被横切并保留原位。在髂总血管水平处解剖并横切输尿管。所有受体输尿管再植均采用留置输尿管支架，留置输尿管支架1个月。术后每两周随访一次移植受者第1个月的血清肌酐功能，此后每月随访一次。所有肌酐升高（大于1.3 mg/dl）或有升高趋势的患者均行移植肾超声检查。临床上显著的输尿管狭窄定义为持续性肾积水导致肾功能受损，需要经皮肾造口管置入或输尿管镜治疗。结果：不保留性腺静脉的腹腔镜活体供体移植术后无明显输尿管狭窄的发生。结论：在腹腔镜供肾切除术中，性腺静脉标本保存是不必要的。保留输尿管周围的血液供应足以防止输尿管狭窄。
Purpose: 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.Materials and Methods: 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 I 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.Results: After laparoscopic living donor transplantation without gonadal vein preservation we found no incidence of clinically significant ureteral stricture.Conclusions: 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.