| Objective: To investigate the operation security,feasibility and the clinical applicationvalue of the living related donor nephrectomy by Laparoscope technique. (LDN).Method: Clinical data of 16 examples of the living-related donor nephrectomy carriedout in our hospital by Laparoscope technique from April 2005 to Dec 2006 wereretrospective analyzed. The average year of donors(1 male and 15 female) was 44.7(range,28-57 years). The average year of recipients (10 male and 6 female) was 34.5(range,17-43 years), the primary lesion of all recipients was chronic glomerulonephfitis. Donorsand Recipients were given complete immunity examination, donors were evaluated aboutsecurity, medical psychology and ethics and GFR test to be sure unilateral renal function,DSA or CTA examination to grasp renal vessel variation. Then 16 donors underwentlaparoscopic nephrectomy, donor kidneys were transplanted to recipients. 9 of which wastranperitoneal (fight 3 cases, left 6 cases); 7 of which was retroperitoneal (right 4 cases,left 3 cases).Results: 16 cases of LDN were performed successfully. There were no donor death, noconverted to open surgery, no apparent operation complications. The operating time was60-85 minutes, mean 81.5±7.79 minutes, left and right LDN operation time was(84.44±3.17)and (77.71±10.42) minutes respectively, P＞0.05; tranperitoneal andretroperitoneal LDN operation time was (82.45±5.79) and (80.28±10.19) minutesrespectively, P＞0.05. the volume of blood loss was about 35-70 ml, mean 47.81±8.56 ml;left and right LDN blood loss was (46.67±7.91)and(49.28±9.76 )ml respectively, P＞0.05;tranperitoneal and retroperitoneal LDN blood loss was (47.22±10.34) and (48.75±5.82)ml respectively, P＞0.05. the warm ischemic time of donor kidney was 60-130 seconds,mean 83.93±16.91 seconds, the cold ischemic time of donor kidney was 30-45 minutes,mean 38.18±4.25 minutes, the final length of renal artery was 2-3.6 centimeters, mean2.81±0.54centimeters, the length of renal vein was 1.5-3.5 centimeters, mean 2.62±0.65centimeters, the final artery length of left and fight donor kidney was (2.38±0.24) and(3.34±0.22) centimeters respectively, P＜0.01; the final length of renal vein was 1.8-3centimeters, mean 2.3 centimeters, the final vein length of left and fight donor kidney was(3.11±0.36) and (1.96±0.27) centimeters respectively, P＜0.01; the length of ureter was8 centimeters or longer. Donors could get up to move 1-2 days after operation, duct wasbe pulled out 2-3 days after operation, hospital stay time was 5-7 days, mean 5.81±0.66days. The SCr of the donors was 54.36-79.17μmol/L before operation, mean 63.91±9.01μmol/L, and 79.56-108.36μmol/L, mean 91.90±9.85μmol/L day four after operation, the average SCr was risen 27.99μmol/L. No complications occurred with living-relateddonors and they were consulted recipients during follow-up of 3-22 months, nohypertension, proteinuria and renal function abnormality were observed. After reperfusionwhen vessel anastomosis were completed, all donor kidneys excrete urine, the time of thegraft reperfused micturition was 25-90 seconds, mean 54.28±17.69 seconds. 15 of whichhad normal function 7 days later after operation, 1 of which were diagnosed as DGF,recovered to normal function 4 weeks later after operation. There were no apparent acuterejection and other complications perioperatively. Conventional immunosuppressive drugwere used. they were consulted recipients for 3-22 months, renal function was normal.The identical twins recipient quited immunosuppressive treatment 6 months afteroperation, had a follow-up visit of 7 months, no rejection were found, renal function keptwell.Conclusions:1. LDN in vivo has the advantages of smaller incision, less blood loss, shorter hospitalstay, and shorter recovery period; it was accepted easily by the donor.2. LDN has no obvious effect on function of donor kidney and the rate of long-termsurviving of the donee after operation.3. Both transperitoneal and retroperitoneal route can be applied in LDN, of which thesurgeon can pick one according to his experience.4. No difference were found in safety and operation time between and left living donor nephrectomy.combination laparoscopic and open techniques to maintain the renal vein in full lengthresult in feasibility of mini-invassive procurement in fight donor kidney, the principle ofbetter kidney for donor nay be in the first place.5. LDN is safety and feasibility in the living related donor kidney transplantation.6. LDN will promote the work of living-donor kidney transplantation, and be wildly recepted by moreand more translated doctors and donors in the future. It may substitute the open live donornephrectomy(ODN). |
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