CAJ | 학술논문

目的回顾分析采用聚丙烯网带经12肋悬吊治疗43例肾下垂患者的安全性和近远期疗效.方法肾下垂患者43例,其中男性14例,女性29例,平均年龄30岁(14～46岁);术前均经B超、CT、IVU等检查确诊为肾下垂,其中右侧29例,左侧10例,双侧4例;影像学分度:Ⅱ度9例,Ⅲ度28例,Ⅳ度6例.手术经腰12肋下切口,裁剪聚丙烯网带经肾纤维囊与脂肪囊之间,托起肾下极使肾脏恢复正常解剖位置,将网带两端穿过12肋近尖部,调整合适长度后缝扎固定.结果 43例患者手术顺利,平均手术时间65min(50～90min),平均住院时间8天(7～9天),术前腰部酸痛、血尿、尿频尿急等症状完全消失;术后随访时间12个月～7年,其中随访24个月以上患者42例;术后定期行B超、IVU等复查,1例患者由术前Ⅳ度下垂恢复至Ⅰ度,余42例均恢复正常解剖位置;其中4例患者术后复发上尿路结石,予药物排石、ESWL术、输尿管镜下钬激光碎石等治愈;2例患者因术前重度积水,术后出现肾萎缩、肾性高血压而行患肾切除;2例患者术后并发腺性膀胱炎,行TURBT术及羟基喜树碱灌注等治愈;1例患者术后并发肾盂肿瘤,行患侧肾脏及输尿管全长切除;2例术前并发Dietl危象者术后恢复正常,随访至今无复发.结论采用聚丙烯网带经12肋行肾脏悬吊治疗肾下垂操作安全简单、术后并发症少、治愈率高、远期效果良好.
목적 회고분석채용취병희망대경12륵현조치료43례신하수환자적안전성화근원기료효.방법 신하수환자43례,기중남성14례,녀성29례,평균년령30세(14～46세);술전균경B초、CT、IVU등검사학진위신하수,기중우측29례,좌측10례,쌍측4례;영상학분도:Ⅱ도9례,Ⅲ도28례,Ⅳ도6례.수술경요12륵하절구,재전취병희망대경신섬유낭여지방낭지간,탁기신하겁사신장회복정상해부위치,장망대량단천과12륵근첨부,조정합괄장도후봉찰고정.결과 43례환자수술순리,평균수술시간65min(50～90min),평균주원시간8천(7～9천),술전요부산통、혈뇨、뇨빈뇨급등증상완전소실;술후수방시간12개월～7년,기중수방24개월이상환자42례;술후정기행B초、IVU등복사,1례환자유술전Ⅳ도하수회복지Ⅰ도,여42례균회복정상해부위치;기중4례환자술후복발상뇨로결석,여약물배석、ESWL술、수뇨관경하화격광쇄석등치유;2례환자인술전중도적수,술후출현신위축、신성고혈압이행환신절제;2례환자술후병발선성방광염,행TURBT술급간기희수감관주등치유;1례환자술후병발신우종류,행환측신장급수뇨관전장절제;2례술전병발Dietl위상자술후회복정상,수방지금무복발.결론 채용취병희망대경12륵행신장현조치료신하수조작안전간단、술후병발증소、치유솔고、원기효과량호.
Objectives To investigate the safety and efficacy of nephroptosis treatment by polypropylene reticular belt nephropexia on the twelfth rib. Methods 43 patients of nephroptosis were treated, including 14 male cases and 29 female cases, aged from 14 to 46 years old. All patients were diagnosed by B-ultrasonography,CT, IVU. There were 29 cases with right side lesions, 10 cases left and 4 cases bilateral. The operations were performed through the lumbar incision, the polypropylene net strings were put between the adipose capsule across the lower pole of the kidney and the fibrous capsule of the kidney. The strings were fixed by silk suture or by rivet after the silk running around the twelfth ribs. Results All operations were successfully done, the average time of the operation was 65 min ( from 50 to 90 min ), the average hospital stay was 8d ( 7 to 9d ). The symptoms of waist soreness, hematuria, frequent micturition were all relieved. The follow-up time was from 12 months to 7 years ( 42 cases had been followed up by above 24 months). 1 case of preoperative Ⅳ grade recovered to Ⅰ grade, and the others all recovered to normal position. 4 cases that recurred stone had been removing urinary calculus by drugs or ESWL or holmium laser operation. 2 cases of severe dropsy had been taken kidney excision for nephrarctia, renal hypertension after operation. 2 cases had been made a definite diagnosis combined with cystitis glandularis and cured by TURBT and pour hydroxy camptothecin. 1 case had been made a definite diagnosis of tumor of renal pelvis and been taken kidney and ureter ablation. 2 cases combined with Dietl syndromes had no recurrences till now. Conclusions The methods of nephroptosis treatment by polypropylene recticular belt nephropexia by twelfth ribs is safely operated and have few complications, high recovery rate and good long-term efficacy.