Fornara P, Doehn C, Jocham D
Department of Urology, Medical University of Lübeck, Germany.
J Urol. 1997 Nov;158(5):1679-83. doi: 10.1016/s0022-5347(01)64093-x.
Operative treatment of nephroptosis is rarely performed and is indicated only in select patients. Postoperatively approach related symptoms and morbidity often limit therapeutic success. We evaluated the technique and outcome of laparoscopic nephropexy in patients with symptomatic nephroptosis. For comparison the records of patients who underwent open nephropexy were reviewed.
Since 1993, 22 women and 1 man 16 to 56 years old (mean age 29) underwent laparoscopic nephropexy at our hospital. Preoperatively excretory urography and radioisotope renography were performed with the patient supine and erect, and careful pain evaluation was also done. For laparoscopic nephropexy the transperitoneal approach was used in all patients. The kidney was completely mobilized by dissection of the perirenal fat. The upper pole and convexity of the kidney were fixed to the muscle using single nonabsorbable sutures and an extracorporeal technique for tying. Between 1984 and 1994, 12 patients underwent open nephropexy at our hospital. The results of this group were reviewed and compared with those treated by laparoscopy.
Mean operative time in the laparoscopy and control groups was 61 (range 40 to 85) and 49 minutes (range 28 to 70), respectively. In patients who underwent laparoscopic nephropexy mean analgesic use was 15 mg. morphine equivalent intravenously and 550 mg. ibuprofen orally. Postoperatively 3 minor complications (13%) were noted. Hospital stay was 3.7 days (range 2 to 9) and patients returned to work after 19 days (range 4 to 30). Six weeks after nephropexy excretory urography showed a correctly positioned kidney. At a mean 13-month followup pain intensity had improved in 21 patients (91%). According to these parameters laparoscopic nephropexy was superior to the open approach except for operative time.
Laparoscopic nephropexy is safe and effective in the select group of patients in whom nephropexy is indicated.
肾下垂的手术治疗很少进行，仅适用于特定患者。术后与手术入路相关的症状和发病率常常限制治疗效果。我们评估了有症状肾下垂患者行腹腔镜肾固定术的技术及疗效。为作比较，回顾了接受开放性肾固定术患者的记录。
自1993年以来，我院有22名女性和1名16至56岁（平均年龄29岁）的男性接受了腹腔镜肾固定术。术前对患者进行仰卧位和站立位排泄性尿路造影及放射性核素肾造影，并仔细评估疼痛情况。所有患者均采用经腹途径进行腹腔镜肾固定术。通过分离肾周脂肪完全游离肾脏。使用单根不可吸收缝线及体外打结技术将肾的上极和凸面固定于肌肉。1984年至1994年期间，我院有12名患者接受了开放性肾固定术。回顾该组结果并与腹腔镜治疗组进行比较。
腹腔镜组和对照组的平均手术时间分别为61分钟（范围40至85分钟）和49分钟（范围28至70分钟）。接受腹腔镜肾固定术的患者平均静脉使用15毫克吗啡等效剂量镇痛药，口服550毫克布洛芬。术后出现3例轻微并发症（13%）。住院时间为3.7天（范围2至9天），患者在19天（范围4至30天）后恢复工作。肾固定术后6周排泄性尿路造影显示肾脏位置正确。平均随访13个月时，21例患者（91%）疼痛强度有所改善。根据这些参数，除手术时间外，腹腔镜肾固定术优于开放手术。
对于有肾固定术指征的特定患者群体，腹腔镜肾固定术安全有效。
