腹腔镜肾固定术(附1例报告并文献复习)

Laparoscopic nephropexy with a report of 1 case and literature review

目的:探讨肾下垂患者行腹腔镜肾固定术的适应证及手术方法。方法:分析1例肾下垂患者行腹腔镜肾固定术的临床资料。术前患者腰痛1个月,站立位可触及右腹部包块。静脉肾盂造影示改变体位后右肾下移超过两个椎体。术中将右肾上、下极分别与腰大肌缝合固定,并用皮下打结方法将右肾中部的腹膜及肾周筋膜悬吊于右12肋上加强固定。结果:手术历时约150min,术中出血约15ml。术后患者恢复良好,平卧休息14d后出院。术后3个月随访患者腰部不适感消失,B超示右肾位于正常位置。结论:腹腔镜肾固定术具有创伤小、恢复快、疗效可靠等优点,可作为症状性肾下垂的首选治疗方法。

Objective： To study the indication and procedure of laparoscopic nephropexy in nephroptosis. Methods ： Laparoscopie nephropexy was performed in a 35-year old man with lumbodynia and a palpable pelvic mass associated with right nephroptosis for more than 1 month. Evaluation by a supine and an erect intravenous urogram revealed right renal descent of more than 2 vertebral bodies. For laparoscopic nephropexy the transperitoneal approach was used in the patient. The upper pole and the lower pole of the right kidney were fixed to the psoas muscle using single nonabsorbable sutures. At the same time, the middle portion of the renal capsule and the peritoneum were fixed to the 12th rib by a subcutaneous or extracorporeal technique for tying which providing additional support for the kidney. Results ：The operation time was 150min, and the blood loss was about 15ml. The hospitalization was 14 days postoperative. At 3 months postoperative,the patient was asymptomatic. An upright type-B ultrasonic 3 months postoperatively revealed the right kidney was in the normal region. Conclusions： Laparoscopic nephropcxy, which has minimal invasion, quicker recovery and more reliable effect, should be considered as the first choice for patients with symptomatic nephroptosis.