開課講師｜陳正彥
課程資訊｜2025.9.20-3
報名方式｜線上報名
課程介紹｜
目的 (Purpose)：
右腎的腎靜脈相對較短，使移植外科醫師在活體腎臟移植時對使用右腎有所顧慮。然而，為了保留捐贈者功能較佳的腎臟，臨床上有時必須面對這樣的挑戰性情況。本研究旨在探討於活體腎臟移植中使用右腎之經驗。
方法 (Materials and Methods)：
自2014年11月至2024年12月，本院共有176位活體腎臟捐贈者。選擇捐贈左腎或右腎的標準為估算腎絲球過濾率（eGFR）較低的一側；若兩側腎臟的eGFR差異在10%以內，則依腎臟血管解剖之簡單程度決定。此外，手術中常規使用捐贈者的右側性腺靜脈或低溫保存血管，以延長右腎靜脈。
結果 (Results)：
176例中有40例使用右腎。前5例採取腹腔鏡輔助手術（經腹腔途徑），其餘35例則採後腹腔途徑。所有病例均無需轉為開放或經腹腔途徑，並能於同一手術野中取得性腺靜脈或低溫保存血管。經靜脈成形術後，右腎靜脈平均可延長1.5–2公分。
結論 (Conclusion)：
依據本研究經驗，在活體腎臟移植中使用右腎是安全可行的。然而，建議常規進行靜脈成形術以延長右腎靜脈。後腹腔途徑不僅能滿足血管移植需求，亦能兼顧腎臟順利摘取
Purpose:
The right kidney has a relatively short renal vein, making transplant surgeons hesitant to use it in living donor kidney transplantation. However, in order to preserve the better kidney for the donor, we sometimes have to deal with this challenging situation. In this report, we discuss our experience with using the right donor kidney in living donor kidney transplantation.
Materials and Methods:
Between November 2014 and December 2024, our institute has had 176 live kidney donors. The criteria for donating the left or right kidney depend on the kidney with a lower estimated glomerular filtration rate (eGFR) or simple renal vessel anatomy if the eGFR difference between the two kidneys is within 10%. Additionally, we routinely extend the right renal vein using the donor’s right gonadal vein or a cryopreserved vein.
Results:
Out of 176 cases, we used 40 right kidneys. In the first 5 cases, we performed a laparoscopic hand-assisted transperitoneal approach. In the remaining 35 cases, we utilized the laparoscopic retroperitoneal approach. None of them were converted to open or transperitoneal routes, and we were able to harvest a segmental gonadal or cryopreserved vein in the same operative field. After venoplasty, the right renal vein could be extended by 1.5-2cm in length.
Conclusion:
Based on our experience, it is safe to use the right kidney in living donor kidney transplantation. However, we recommend routinely performing venoplasty to lengthen the right renal vein. The retroperitoneal approach can achieve both the goals of vein grafting and kidney procurement.
講師介紹｜
