应用聚丙烯网带治疗肾下垂的临床研究

The clinical research of nephroptosis treatment by polypropylene reticular belt ne- phropexia on the twelfth rib

目的回顾分析采用聚丙烯网带经12肋悬吊治疗43例肾下垂患者的安全性和近远期疗效。方法肾下垂患者43例，其中男性14例，女性29例，平均年龄30岁（14～46岁）；术前均经B超、CT、IVU等检查确诊为肾下垂，其中右侧29例，左侧10例，双侧4例；影像学分度：Ⅱ度9例，Ⅲ度28例，Ⅳ度6例。手术经腰12肋下切口，裁剪聚丙烯网带经肾纤维囊与脂肪囊之间，托起肾下极使肾脏恢复正常解剖位置，将网带两端穿过12肋近尖部，调整合适长度后缝扎固定。结果43例患者手术顺利，平均手术时间65min（50—90min），平均住院时间8天（7～9天），术前腰部酸痛、血尿、尿频尿急等症状完全消失；术后随访时间12个月～7年，其中随访24个月以上患者42例；术后定期行B超、IVU等复查，1例患者由术前Ⅳ度下垂恢复至I度，余42例均恢复正常解剖位置；其中4例患者术后复发上尿路结石，予药物排石、ESWL术、输尿管镜下钬激光碎石等治愈；2例患者因术前重度积水，术后出现肾萎缩、肾性高血压而行患肾切除；2例患者术后并发腺性膀胱炎，行TURBT术及羟基喜树碱灌注等治愈；1例患者术后并发肾盂肿瘤，行患侧肾脏及输尿管全长切除；2例术前并发Dietl危象者术后恢复正常，随访至今无复发。结论采用聚丙烯网带经12肋行肾脏悬吊治疗肾下垂操作安全简单、术后并发症少、治愈率高、远期效果良好。

Objectives To investigate the safety and efficacy of nephroptosis treatment by polypropylene reticular belt nephropexia on the twelfth rib. Methods 43 patients of nephroptosis were treated, including 14 male cases and 29 female cases, aged from 14 to 46 years old. All patients were diagnosed by B -uhrasonography, CT, IVU. There were 29 cases with right side lesions, 10 cases left and 4 cases bilateral. The operations were performed through the lumbar incision, the polypropylene net strings were put between the adipose capsule across the lower pole of the kidney and the fibrous capsule of the kidney. The strings were fixed by silk suture or by rivet ＇after the silk running around the twelfth ribs. Results All operations were successfully done, the average time of the operation was 65 rain （ from 50 to 90 min ）, the average hospital stay was 8d （ 7 to 9d ）. The symptoms of waist soreness, hematuria, frequent micturition were all relieved. The follow -up time was from 12 months to 7 years （ 42 cases had been followed up by above 24 months）. 1 case of preoperative IV grade recovered to I grade, and the others all recovered to normal position. 4 cases that recurred stone had been removing urinary calculus by drugs or ES- WL or holmium laser operation. 2 cases of severe dropsy had been taken kidney excision for nephrarctia, renal hypertension after operation. 2 cases had been made a definite diagnosis combined with cystitis glandularis and cured by TURBT and pour hydroxy camptothecin. 1 case had been made a definite diagnosis of tumor of renal pelvis and been taken kidney and ureter ablation. 2 cases combined with Dietl syndromes had no recurrences till now. Conclusions The methods of nephroptosis treatment by polypropylene recticular belt nephropexia by twelfth ribs is safely operated and have few complications, high recovery rate and good long - term efficacy.