聚丙烯网带经第12肋悬吊术治疗肾下垂七例报告

Treatment of nephroptosis by polypropylene ventrofixation on the twelfth rib （report of 7 cases）

目的探讨聚丙烯网带经第12肋悬吊术治疗肾下垂的手术疗效。方法肾下垂患者7例。男2例，女5例。年龄14～46岁。身高150～183cm，体质量45～68kg。右侧5例，左侧1例，双侧1例。均经B超、CT、站立位IVU检查确诊，肾下垂放射学分度Ⅱ度1例、Ⅲ度3例、Ⅳ度3例。手术经腰肋切口，采用聚丙烯网带经肾纤维囊和脂肪囊之间绕过肾脏及其下极，调整网带长度至肾脏恢复正常解剖位置，将两端穿过第12肋后用丝线缝扎固定。IVU复查比较手术前后肾脏位置。结果7例患者手术顺利，平均手术时间65（50～90）min，平均住院时间8（7～9）d，平均卧床时间7（6～8）d。患者术前腰酸、腰痛、血尿、尿频、尿急等症状完全消失。术后随访12～36个月，平均24个月，IVU示患肾均恢复至正常位置。4例肾积水患者中，1例中重度积水者积水明显减轻，肾脏形态基本恢复正常，余3例完全恢复正常；1例反复尿路感染者，尿沉渣细胞学复查阴性，尿路刺激症状消失；1例阵发性血尿者血尿消失；1例合并Dietl危象者术后症状消失。结论聚丙烯网带经第12肋肾脏悬吊术治疗肾下垂简单易行、操作安全、并发症少，治愈率高。

Objective To discuss a new method on treatment of the nephroptosis. Methods Seven patients of nephroptosis were treated with polypropylene ventrofixation on the twelfth rib. There were 2 male cases and 5 females. The patients aged from 14 to 46 years old. Height were among 150 and 183 cm and weight from 45 to 68 kg. There were 5 cases with right side lesions, 1 case left and 1 case bilateral. The operation was performed through the lumbar incision. A polypropylene net string was put between the fibrous capsule of the kidney and the adipose capsule, across the lower pole of the kidney. After adjusted the tension, the string was fixed by silk suture or by rivet after the silk running around the twelfth rib. IVU （intravenous urogram） was performed to compare the position of kidney pre- and post operation. Results The operations were successfully done. Average time of the operation was 65 min（from 50 to 90 min） and average hospital stay was 8 d（from 7 to 9 d）. Average time lying in bed was 7 d （between 6 and 8 d）. The symptoms of waist soreness, lumbodynia, hematuria, frequent micturition relieved. The follow up time was from 12 to 36 months with an average of 24 months. In 4 cases of hydronephrosis and calculus, 3 cases were cured and 1 case was lightened. One case of repeated urinary tract infection, urinary sediment was normal and irritation symptoms disappeared. For 1 case with Dietl syndrome, the symptoms of nephric colic, nausea, pallor, exhaustion, hematuria disappeared. Conclusion The Polypropylene ventrofixation on twelfth rib might be alternative treatment choice for nephroptosis.