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目的:探讨后腹腔镜下肾固定术的手术方法和疗效。方法:采用后腹腔镜下手术治疗肾下垂28例。28例患者均为女性。年龄26~45岁,平均(34±2.5)岁。右侧15例,左侧12例,双侧1例。术前症状:腰区酸胀27例,腰区明显疼痛1例,频发尿路感染16例,血尿12例,其中肉眼血尿8例,镜下血尿4例。肾图显示患侧呈梗阻性表现12例。静脉肾盂造影提示肾下垂Ⅱ度10例,Ⅲ度14例,Ⅳ度4例。患侧轻度肾积水7例。1例双侧肾下垂采用经腹途径,其余27例均采用后腹腔途径。经后腹腔镜完整游离患侧肾脏,其中8例钳夹牵拉的肾下极血管。26例将下垂游离肾脏用腔镜内缝合技术固定于腰大肌,2例用外打结方法固定于患侧腰区皮下。结果:28例手术均获得成功。平均手术时间(125±9)min,平均住院时间(8±1.2)d,平均卧床时间(7±1.3)d。术后复查静脉肾盂造影提示患侧肾脏位于正常位置。27例腰区酸胀患者中24例症状消失,3例改善;1例腰区疼痛患者症状消失;16例频发尿路感染患者症状均消失;12例血尿患者中有10例症状消失。平均随访(24±4.2)个月,有一定的复发症状,包括血尿复发2例,1例复发尿路感染,4例复发患侧腰区酸胀。结论:后腹腔镜手术具有创伤小、疼痛轻、康复快等优点,有望成为理想的肾下垂手术方法之一。
Objective: To investigate the surgical methods and effects of retroperitoneal nephrectomy. Methods: Retroperitoneal laparoscopic surgery in 28 cases of renal ptosis. All 28 patients were female. Aged 26 to 45 years, mean (34 ± 2.5) years. Right in 15 cases, left in 12 cases, bilateral in 1 case. Preoperative symptoms: soreness in lumbar region in 27 cases, lumbar pain in 1 case, frequent urinary tract infection in 16 cases, hematuria in 12 cases, including gross hematuria in 8 cases, microscopic hematuria in 4 cases. Renogram showed obstruction of ipsilateral performance in 12 cases. Intravenous pyelography showed renal ploidy Ⅱ degree in 10 cases, Ⅲ degree in 14 cases, Ⅳ degree in 4 cases. 7 cases of mild hydronephrosis ipsilateral. One case of bilateral renal prolapse using the transabdominal approach, and the remaining 27 cases were using the retroperitoneal approach. Complete retro-laparoscopic ipsilateral free kidney, of which 8 cases of mandibular renal traction subarachnoid vessels. 26 cases of sagging free kidney laparoscopic suture fixation in the psoas muscle, 2 cases of external knot method fixed in the ipsilateral lumbar subcutaneous. Results: All 28 cases were successful. The average operation time was (125 ± 9) min, the average length of hospital stay was (8 ± 1.2) days and the average bed rest time was (7 ± 1.3) days. Postoperative review of intravenous pyelography prompted ipsilateral kidneys in the normal position. Twenty-four patients with soreness in the lumbar region disappeared in 24 cases, and 3 cases improved. One patient with lumbar pain disappeared. The symptoms disappeared in 16 patients with frequent urinary tract infection. Ten of 12 hematuria patients disappeared. The patients were followed up for an average of (24 ± 4.2) months with some recurrent symptoms, including 2 cases of hematuria recurrence, 1 case of recurrent urinary tract infection and 4 cases of recurrent lateral sore area. Conclusion: Retroperitoneal laparoscopic surgery has the advantages of less trauma, less pain and quick recovery. It is expected to become an ideal method for renal ptosis.