Sizonov V V, Kogan M I
Urologiia. 2011 Jul-Aug(4):3-7.
Rotation of the kidney is caused by its dystopia and abnormal blood circulation. Dorsal rotation of the kidney in normal position is a rare anomaly. We studied a clinical course, evidence obtained at renosonography, excretory urography, computed tomography, radionuclide investigation, anatomic variants of pyeloureteral segment obstruction in female patients with right-side hydronephrosis in the presence of dorsal rotation of the kidney before and after pyeloplasty. We made pyeloplasty for obstruction of the pyeloureteral segment in 266 patients in 2001-2009. Hydronephrosis was accompanied with dorsal rotation of the kidney in 21 (7.9%) cases. Surgical approaches to the pelviureteral segment are characterized. The dorsal approach is a good alternative to standard subcostal approach, provides good visualization in creation of anastomosis, significantly reduces distance from the skin cut to pyeloureteral segment and offers the best cosmetic result. In subcostal approach mobilization of the pelvis and pyeloureteral segment is preferable on the posterior surface of the kidney. A laparoscopic transperitoneal approach is not justified as it implies wide mobilization of the kidney, the anastomosis is created in extremely limited space.
肾脏旋转是由其异位和异常血液循环引起的。正常位置的肾脏背侧旋转是一种罕见的异常情况。我们研究了肾盂成形术前后，存在肾脏背侧旋转的右侧肾积水女性患者的临床病程、肾脏超声检查、排泄性尿路造影、计算机断层扫描、放射性核素检查所获得的证据以及肾盂输尿管段梗阻的解剖变异情况。2001年至2009年期间，我们对266例肾盂输尿管段梗阻患者进行了肾盂成形术。21例（7.9%）肾积水伴有肾脏背侧旋转。文中描述了肾盂输尿管段的手术入路。背侧入路是标准肋下入路的良好替代方法，在进行吻合时能提供良好的视野，显著缩短从皮肤切口到肾盂输尿管段的距离，并能获得最佳的美容效果。在肋下入路中，在肾脏后表面游离肾盂和肾盂输尿管段更为可取。腹腔镜经腹入路并不合理，因为这意味着要广泛游离肾脏，且吻合是在极其有限的空间内进行。
