肾下垂的诊断治疗与微创手术(附396例报告)

Diagnosis and treatment of nephroptosis and realization of minimally invasive nephropexy

目的 探讨肾下垂的误诊漏诊及其治疗措施,初步总结后腹腔镜下自制网袋肾固定术的疗效.方法 回顾分析10年余（1996年10月～2006年8月）的396例肾下垂病人临床症状、误诊漏诊原因及内科保守治疗适应证.结果 腰部酸痛不适、血尿是肾下垂的常见症状,一些病人还可出现消化症状及神经官能症症状,Dietl危象少见.造成肾下垂误诊漏诊的主要原因是临床医师对疾病的疏忽及超声、静脉尿路造影中未作坐位或站位检查.大部分肾下垂病人内科保守治疗有效.结论 医师的重视及坐位或站位作超声和静脉尿路造影可避免对肾下垂的误诊漏诊.内科治疗对大部分肾下垂病人有效,后腹腔镜下自制丝线网袋悬吊下垂肾脏有应用前途.

Objective To enunciate the results of misdiagnosis of nephroptosis and its treatment and to summarize clinical value of retroperitoneal laparoscopic nephropexy with self - made cotton thread reticule. Methods The different symptoms and results of misdiagnosis of 396 patients with nephroptasis in more than 10 years were analysed retrospectively. The indication of consecutive therapy and the retroperitoneal laparoscopic nephropexy with self - made cotton thread reticule were also described. Results For patients with nephroptosis, flank pain, hematuria were the common symptoms, digestive symptoms and neurosis symptoms might present in some patients. Dietl＇s crisis was rare. The main causes of misdiagnosis for nephroptosis were as following the negligence of the disease, the wrong position （ only supine） during examination of ultrasonography and intravenous ruography. The majority of patients with nephroptosis were responsible to the consecutive therapy. The results of retoperitoneal laparoseopic nephropexy with self - made cotton thread reticule in 8 patients were satisfied. Conclusion Flank pain, hematuria are the common symptoms in patients with nephroptosis. More attention should be paid for nephroptosis. Standing or siting position during ultrasonography and intravenous urography is important to avocid misdvagnosis of the disease. Consecutive therapy is useful and retroperitoneal laparoseopie nephropexy with self - made cotton thread reticule is promising for patients with nephroptosis.