Elashry O M, Nakada S Y, McDougall E M, Clayman R V
Division of Urology, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
J Urol. 1995 Nov;154(5):1655-9. doi: 10.1016/s0022-5347(01)66740-5.
We evaluated the efficacy of laparoscopic nephropexy for symptomatic nephroptosis.
We performed laparoscopic right nephropexy in 6 patients who presented with symptomatic nephroptosis documented by radiographic studies and/or renal scans. In the first patient Gerota's fascia was secured to the peritoneal reflection of the line of Toldt using tacking clips. In the subsequent 5 patients the lateral border of the kidney was sutured to the overlying fascia of the quadratus lumborum muscle using an intracorporeal suturing technique. Additionally, the superior edge of the incised infrahepatic triangular ligament was sutured to the anterior mid portion of the renal capsule, thereby creating a vertical and horizontal means of fixation.
Laparoscopic right nephropexy was successful in all 6 patients. Average operative time was 4 hours. All patients resumed oral intake during postoperative day 1. Average parenteral analgesia requirement postoperatively was 42.7 mg. morphine. Hospital stay averaged 2.5 days and patients returned to usual activities an average of 2.5 weeks postoperatively. Postoperative imaging studies confirmed a decrease in or resolution of nephroptosis in all patients. All patients remained asymptomatic for an average of 11 months (range 2 to 30).
Laparoscopic nephropexy appears to be a feasible treatment option for patients with symptomatic, documented nephroptosis. The procedure can be accomplished safely and effectively with satisfactory anatomical and clinical results.
我们评估了腹腔镜肾固定术治疗症状性肾下垂的疗效。
我们对6例经影像学检查和/或肾脏扫描证实有症状性肾下垂的患者实施了腹腔镜右肾固定术。第一例患者使用钉合夹将肾周筋膜固定于Toldt线的腹膜返折处。在随后的5例患者中，采用体内缝合技术将肾脏外侧缘缝合至腰方肌上覆筋膜。此外，将切开的肝下三角韧带的上缘缝合至肾包膜的前中部，从而形成垂直和水平固定方式。
6例患者的腹腔镜右肾固定术均成功。平均手术时间为4小时。所有患者术后第1天恢复经口进食。术后平均非肠道镇痛需求量为42.7毫克吗啡。平均住院时间为2.5天，患者术后平均2.5周恢复日常活动。术后影像学检查证实所有患者肾下垂减轻或消失。所有患者平均11个月（范围2至30个月）无症状。
对于有症状且经证实的肾下垂患者，腹腔镜肾固定术似乎是一种可行的治疗选择。该手术可安全有效地完成，获得满意的解剖学和临床效果。
