后腹腔镜自制网袋肾固定术与开放手术疗效评估

Retroperitoneal laparoscopic nephropexy with self-made net versus open nephropexy

目的:总结后腹腔镜下自制丝线网袋肾悬吊固术与开放手术治疗肾下垂的疗效。方法:回顾性分析我院两院区1995-2007年用自制丝线网袋悬吊固定下垂肾脏患者的临床资料,其中开放手术组16例17侧,腹腔镜手术组13例14侧。结果:腹腔镜手术组均成功。腹腔镜手术组与开放手术组平均手术时间分别为100min和110min,平均出血量为25mL和120mL,平均恢复饮食时间为8h和48h,术后平均住院时间为15.5d和16.0d。开放手术组平均随访8.6年,10例(62%)症状消失,6例减轻。腹腔镜手术组平均随访1.6年,11例(85%)症状消失,2例减轻。两组并发症发生率分别为开放手术组38%和腹腔镜手术组8%。术后3个月复查证实两组患者肾脏位置均正常。结论:自制丝线网袋悬吊下垂肾脏固定牢靠、疗效确切。后腹腔镜下肾悬吊固定术具有微创、出血少、恢复快、无明显并发症等优点,值得推广应用。

Objective To explore the efficacy of retroperitoneal laparoscopic nephropexy with self-made silk thread net versus that of open nephropexy. Methods 16 patients with nephroptosis undergoing open nephropexy （group 1 ） and 13 those receiving laparoscopic nephropexy （group 2） from 1995 to 2007 were retrospectively reviewed. Results Laparoscopic nephropexy was successfully performed on all of the patients. The mean operation time was 100 min in group 2 and 110 min in group 1, mean blood loss was 25.0 mL and 120.0 mL, average food-intake restoration time was 8 h and 48 h, mean postoperative hospital stay was 15.5 days and 16.0 days, and incidence of complications was 8% and 38%, respectively. In group 1, 10 patients （62%） had complete symptom relief and the remaining 6 had partial relief during a mean 8.6-year follow-up; while in group 2, 11 patients （85%） had complete relief and two had partial relief during a mean 1.6-year follow-up. All of the kidneys were confirmed to remain in normal position 3 months after either procedure. Conclusion Retroperitoneal laparoscopic nephropexy with self-made net, as compared with open nephropexy, is safe, effective and minimally invasive, therefore, deserves to be popularized.