Cinman Nadya M, Okeke Zeph, Smith Arthur D
Department of Urology, North-Shore Long Island Jewish Medical Center, New Hyde Park, New York 11040-1496, USA.
J Endourol. 2007 Aug;21(8):836-42. doi: 10.1089/end.2007.9945.
The incidence of pelvic kidney has been approximated at between 1 in 2200 and 1 in 3000. The ectopic kidney is thought to be no more susceptible to disease than the normally positioned kidney, except for the development of calculi and hydronephrosis. Because of the greater risk of injuring aberrant vessels or overlying abdominal viscera and nerves, the pelvic kidney presents special treatment challenges. Alternative approaches to treating nephrolithiasis may yield better outcomes. The tortuous ureter often associated with a pelvic kidney hinders deflection of the flexible ureteroscope, potentially limiting access. Laparoscopy-guided intervention permits visual exposure of the kidney, enhancing safe puncture and tract placement integral to percutaneous nephrolithotomy. Laparoscopy-assisted anterior retrograde percutaneous nephroscopy involves percutaneous access using a Hunter-Hawkins retrograde nephrostomy needle with adjunctive laparoscopy to permit viewing and manipulation of overlying bowel. Ureteropelvic junction (UPJ) obstruction has been reported to occur in 22% to 37% of ectopic kidneys. Endoscopic incision presents difficulties beyond those of anatomically normal kidneys. The laparoscopic approach provides good surgical exposure, and operative times are comparable to those of laparoscopic pyeloplasty in anatomically normal kidneys. To date, only a handful of cases of malignancy in a pelvic kidney have been described. Like a nonfunctioning anatomically normal kidney, a nonfunctional pelvic kidney may require primary removal. There are a few reports of laparoscopic pelvic nephrectomy. Additional studies are needed to compare the various treatments for disease of the pelvic kidney in order to decide which options have the most beneficial outcomes.
盆腔肾的发病率估计在2200分之一至3000分之一之间。除了结石和肾积水的发生外，异位肾被认为与正常位置的肾脏相比，对疾病的易感性并无差异。由于损伤异常血管或上方腹部脏器及神经的风险更高，盆腔肾带来了特殊的治疗挑战。治疗肾结石的替代方法可能会产生更好的效果。盆腔肾常伴有的迂曲输尿管会阻碍可弯曲输尿管镜的偏转，可能限制进入。腹腔镜引导下的干预可使肾脏可视化，增强经皮肾镜取石术中安全穿刺和通道放置的操作。腹腔镜辅助前路逆行经皮肾镜检查包括使用亨特 - 霍金斯逆行肾造瘘针经皮进入，并辅以腹腔镜以观察和操作上方的肠管。据报道，输尿管肾盂连接处（UPJ）梗阻在22%至37%的异位肾中发生。内镜切开比解剖结构正常的肾脏面临更多困难。腹腔镜手术方法能提供良好的手术视野，手术时间与解剖结构正常肾脏的腹腔镜肾盂成形术相当。迄今为止，仅描述了少数盆腔肾恶性肿瘤病例。与无功能的解剖结构正常的肾脏一样，无功能的盆腔肾可能需要一期切除。有一些腹腔镜盆腔肾切除术的报道。需要进一步研究以比较盆腔肾疾病的各种治疗方法，从而确定哪种选择具有最有益的结果。
