손을 이용한 복강경 공여신적출술 후 이식신의 요관합병증: 관혈적수술과의 비교
Ureteral Complications of the Transplanted Kidney after Hand-Assisted Laparoscopic Donor Nephrectomy: Comparison with Open Procedure
오우석, 권준범, 유은상, 권태균,
소속 상세정보
오우석 ( Oh Woo-Seok )
경북대학교 의과대학 비뇨기과학교실
권준범 ( Kwon Joon-Beom )
경북대학교 의과대학 비뇨기과학교실
유은상 ( Yoo Eun-Sang )
경북대학교 의과대학 비뇨기과학교실
권태균 ( Kwon Tae-Gyun )
경북대학교 의과대학 비뇨기과학교실
KMID : 0358320090500030256
Abstract
Purpose: We compared recipients’ ureteral complications after hand-assisted laparoscopic donor nephrectomy (HALDN) and open donor nephrectomy (ODN).
Materials and Methods: Between January 1999 and September 2006, a total of 166 transplantaions were underwent via a HALDN or ODN. Kidney transplantation was performed in a standard fashion and ureteroneocystostomy was done by extravesical Lich-Gregoir method. We retrospecitvely compared 2 groups with regard to ureteral complications and functional recovery of transplanted kidney.
Results: Twenty-six right kidneys (26/88) were transplanted in HALDN and 20 right kidneys (20/78) were done in ODN. 18 multiple arteries were found in HALDN and 13 in ODN. The mean ischemic time of HALDN and ODN was 270 and 290 seconds. If short length of ureter or anastomosis site swelling was found, ureteral catheter was inserted to ureter of recipient (HALDN: 12, ODN: 3). Four ureteral complications were happened in HALDN group; five in ODN group. In HALDN, two ureteral leakages, one ureteral stricture and one ureteral leakage with anastomosis site narrowing were developed. In ODN, one vesicoureteral reflux, three ureteral leakages and one ureteral stricture were developed. Laterality and multiple renal arteries were not related with ureteral complications. Only ureteral stent insertion reduced ureteral complications (p＜0.05). Acute rejection in 1 year were 6 patients in HALDN and 4 patients in ODN. In HALDN, 1-year patient and graft survival was 98.9% (87/88) and 95.5% (84/88); In ODN 100% (78/78) and 98.7% (77/78).
Conclusions: In comparison with ODN, HALDN combined with the extravesical ureteral implantation technique provides similar graft outcomes with low ureteral complication rate. These results suggest that HALDN is safe and effective comparable recipient surgical outcomes.
키워드
Kidney transplantation;Nephrectomy;Ureteral complication
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