生体腎移植における後腹膜鏡下ドナー腎摘出術―術式のポイント―

Retroperitoneoscopic donor nephrectomy for living kidney transplantation

◆要旨：当科では2001年より後腹膜鏡下ドナー腎摘出術を行っている．ドナー腎摘出術に求められるものは安全性と摘出腎の機能温存であり，この点で，①丁寧な剝離，②フレキシブルタイプスコープの使用，③背側から腎門部両脇の剝離，④左手の使い方，などにポイントを置いている．主な合併症として開放手術への移行症例，輸血施行症例がそれぞれ1例，尿管合併症が4例あるが，腸管合併症や周辺臓器損傷，そのほかの重篤な合併症は経験していない．早期移植腎機能においてdelayed graft function症例もなく，ドナー腎摘出術において当術式は安全性や摘出腎機能の点においても選択すべき術式の1つである．

　We have tried to establish the technique of retroperitoneoscopic live donor nephrectomy（RPLDN）since 2001. Both the safety and the stable condition of allograft function are needed in RPLDN. In order to perform complete RPLDN, careful dissection using flexible scope, the dorsal dissection at both side of the renal hilum, and the usage of the left hand during the operation were given full attention. No serious complications, such as another organ injury, were encountered except for one patient whose operation was converted to open surgery, one patient with blood transfusion after the surgery, and 4 patients with ueteral complications. No patients required hemodialysis after transplantation due to acute tubular necrosis. These results suggested that excellent donor safety and allograft function were obtained with RPLDN.