后腹腔镜肾固定术结合补中益气汤治疗肾下垂13例

目的:总结后腹腔镜下自制丝线网袋肾悬吊固定术结合补中益气汤加减治疗肾下垂的疗效。方法:术前服用补中益气汤加减治疗15～60d,均行后腹腔镜下自制丝线网袋肾悬吊固定术。结果:手术均成功,平均手术时间为100min,术后第2d开始继续服用中药15～30d。随访1.6年,12例症状完全消失,1例症状减轻。3个月后坐立位超声或IVU证实,肾脏位置正常。结论:后腹腔镜下自制丝线网袋肾悬吊固定术结合补中益气汤加减治疗肾下垂,临床疗效确切,值得推广应用。     

腹腔镜肾固定术(附1 例报告并文献复习)

目的：探讨肾下垂患者行腹腔镜肾固定术的适应证及手术方法。方法：分析1例肾下垂患者行腹腔镜肾固定术的临床资料。术前患者腰痛1个月，站立位可触及右腹部包块。静脉肾盂造影示改变体位后右肾下移超过两个椎体。术中将右肾上、下极分别与腰大肌缝合固定，并用皮下打结方法将右肾中部的腹膜及肾周筋膜悬吊于右12肋上加强固定。结果：手术历时约150min，术中出血约15ml。术后患者恢复良好，平卧休息14d后出院。术后3个月随访患者腰部不适感消失，B超示右肾位于正常位置。结论：腹腔镜肾固定术具有创伤小、恢复快、疗效可靠等优点，可作为症状性肾下垂的首选治疗方法。     

后腹腔镜肾上极筋膜悬吊结扎法肾蒂淋巴管剥脱术治疗乳糜尿（附16例报告）

目的：探讨后腹腔镜肾上极筋膜悬吊结扎法肾蒂淋巴管剥脱术治疗乳糜尿的手术方法和疗效。方法：采用后腹腔镜肾上极筋膜悬吊结扎法肾蒂淋巴管剥脱术治疗乳糜尿患者16例,男5例,女ll例,年龄54～74岁,平均（64．7±6．6）岁。所有患者均观察手术时间、术中出血量、术后住院时间、并发症及其预后,并对临床相关指标进行分析。结果：16例患者手术均顺利完成,无中转开放手术者。手术时间48～65min,平均（55．9±5．9）min。术中出血量20～70ml。术后住院时间5～7d,平均（6．4±2．0）d。所有患者术后乳糜尿消失。随访16～36个月,无一例复发,未出现。肾下垂、肾蒂周围出血等并发症。结论：经后腹腔镜’肾上极筋膜悬吊结扎法肾蒂淋巴管剥脱术是一种治疗乳糜尿安全、可行的手术方法,值得临床推广。     

再行腹腔镜肾脏手术的可行性

目的：探讨既往有肾脏手术史者再行腹腔镜肾脏手术的可行性。方法：4例肾积水患者均有经腰切口肾脏手术史，其中2例经腹入路行腹腔镜肾切除，1例经腹膜后入路行腹腔镜肾切除，1例经腹膜后入路行腹腔镜肾盂成形术。结果：4例腹腔镜手术均获得成功，无术中及术后并发症发生。经腹入路手术时间平均2．5h，术中出血量约50ml，经腹膜后入路腹腔镜肾切除术手术时间3h，腹腔镜肾盂成形术手术时间4．5h，出血量80～100ml。结论：对于既往有肾脏手术史者，虽然因瘢痕粘连增加了手术难度，但随着腹腔镜手术经验的积累和手术技能的提高，再行腹腔镜肾脏手术是可行的。     

腹膜后入路3D腹腔镜肾脏手术探讨:附视频

目的探讨腹膜后入路3D腹腔镜进行常见肾脏手术的技巧和安全性。方法 2012年11月至2014年3月,中山大学孙逸仙纪念医院泌尿外科对103例常见肾脏疾病患者行了腹膜后入路3D腹腔镜手术,其中肾癌根治术28例,肾部分切除术28例,单纯肾切除术24例,肾囊肿去顶减压术12例,肾盂输尿管离断成形术11例。观察指标主要包括手术时间、出血量、术后住院时间、并发症等。结果 103例患者均在3D腹腔镜下顺利完成手术,无中转开放手术或者常规腹腔镜手术病例,所有病例无重大并发症发生。3D腹腔镜肾癌根治术中位手术时间70 min,平均出血量60 ml,术后住院时间平均5 d。3D腹腔镜肾部分切除术中位手术时间90 min,平均热缺血时间22 min,平均出血量90 ml,术后住院时间平均6 d,无切缘阳性病例。3D腹腔镜单纯肾切除术中位手术时间60 min,平均出血量50 ml,术后住院时间平均5 d。3D腹腔镜肾囊肿去顶减压术中位手术时间40 min,平均出血量30 ml,术后住院时间平均3 d。3D腹腔镜肾盂输尿管离断成形术中位手术时间80 min,平均出血量50 ml,术后住院时间平均6 d。结论腹膜后入路3D腹腔镜进行常见肾脏手术安全可行,尤其是镜下缝合精准快速,值得在已经熟练掌握腹腔镜技术的医院推广应用。     

后腹腔镜下聚丙烯网带经腰肌肾固定术治疗肾下垂(附15例报道)

目的 探讨后腹腔镜下聚丙烯网带经腰肌肾固定术治疗症状性肾下垂的可行性和疗效.方法 2008年12月以来对15例行立卧位IVU或CT检查确诊为肾下垂患者行后腹腔镜下游离肾脏,采用自行修剪聚丙烯网带绕肾脏中下极,经腰部肌群(腹内外斜肌、腰大肌、腰方肌)穿出,并于皮下与肌筋膜缝合固定.结果 15例手术均获成功,无中转开放.手术时间40～ 120rin,平均80min.术中术后无并发症发生.随访12～48个月,术后所有患者腰部酸痛症状较术前明显缓解.术前伴有肉眼血尿和反复出现尿路感染的患者,术后症状消失.术后复查IVU均提示患肾复位固定良好.结论 后腹腔镜下聚丙烯网带肾固定术治疗症状性肾下垂技术可行,创伤小,恢复快,安全有效,并发症少,操作简单,疗效确切,是治疗症状性肾下垂的有效术式,值得推广.     

改良后腹腔镜肾蒂周淋巴管阻断术治疗乳糜尿7例的临床观察

目的探讨经后腹膜腔利用腹腔镜改良肾蒂周淋巴管阻断术治疗乳糜尿的疗效。 方法2017年3月至2018年7月,茂名市电白区人民医院泌尿外科对7例乳糜尿患者行腹腔镜改良肾蒂周淋巴管阻断术治疗,观察7例患者的手术时间、术中出血量、引流管与尿管的拔管时间、术后连续3 d的乳糜尿试验结果及术后不良反应的发生情况,术后随访2～17个月。 结果7例患者手术均于镜下顺利完成,平均手术时间为75 min,术中平均出血量为7.5 ml;于术后1～4 d拔除腹膜腔引流管,6～7 d拔除尿管;所有患者术后即无乳白色尿液,术后连续3 d复查乳糜尿试验均为阴性;随访期间,均无明显肾周下坠痛及患侧肾下垂情况发生。1例复发者经改善饮食及减少运动量1周后乳糜尿症状消失。 结论经后腹膜腔利用腹腔镜改良肾蒂周淋巴管阻断术治疗乳糜尿保持了肾门部血管、肾盂生理性伸直,手术时程短,术中出血少,患者临床症状消失快,疗效确切。     

腹膜后腔入路腹腔镜肾囊肿去顶术20例

目的探讨腹膜后腔入路腹腔镜下肾囊肿去顶术的技术要点和手术疗效。方法20例患者均在全麻下用自制水囊建立后腹膜腔,距肾实质5mm用电钩或电剪切除囊壁。结果所有囊肿均顺利去顶,手术时间30—90min,平均35min,术中出血量10—80ml,平均30ml,术后平均住院时间3～10天,所有病理报告均为良性病变,随访8～48个月,20例均未见囊肿复发。结论腹膜后腔入路腹腔镜肾囊肿去顶术安全有效。     

后腹腔镜手术治疗肾脏肿瘤5例报告

目的：探讨后腹腔镜肿瘤剜除术和肾部分切除术治疗肾脏肿瘤的应用价值。方法：采用后腹腔镜经后腹腔途径对5例肾肿瘤患者分别行肿瘤剜除术和肾部分切除术，并观察手术时间，术中出血量，术后住院天数和术中术后并发症及手术效果。结果：5例手术全部获得成功，平均手术时间为87min，平均出血量55ml，平均术后住院时间为5．8d，手术效果好，无并发症。结论：该术式肿瘤切除精确彻底，创伤小，出血少，恢复快，有推广应用价值。     

后腔镜三套管自制套索控制肾血管下肾脏肿瘤切除术

目的：探讨后腔镜下肾脏肿瘤切除术中使用三套管自制套索控制肾血管临床应用的可行性。方法：后腔镜三套管自制套索控制肾血管下行肾脏肿瘤切除术5例。5例患者术前无或仅有轻微腰痛，无肉眼血尿及腰部包块，经肾脏B超、CT、MRI检查明确肾脏肿块。结果：本组5例手术均获得成功。手术时间130～180min，平均145min。术中出血量50～150m1，平均85ml。术后住院时间7～9天，平均为8天。肾周引流管留置5天，无并发症。随访4～12个月，B超、CT检查未见肿瘤复发。结论：后腔镜肾肿瘤切除术具有患者创伤小，出血少，康复快，并发症少等优点，而采用三套管自制套索控制肾血管具有操作简单，干扰少，经济等优点。     

Retroperitoneoscopic nephropexy for symptomatic nephroptosis

PURPOSE: Recently, laparoscopic nephropexy has been performed using a transperitoneal approach. We evaluated the efficacy of a retroperitoneoscopic technique for symptomatic nephroptosis. PATIENTS AND METHODS: Three men and two women with right nephroptosis underwent retroperitoneal laparoscopic nephropexy. Their symptoms were right flank pain, gross hematuria, or both. The mean body mass index was 18.7. Surgery consisted of complete dissection of the kidney, after which three sutures were placed between the renal capsule at the posterior lateral edge and the psoas or quadratus lumborum muscle. Silk sutures were used in all five patients. RESULTS: Retroperitoneoscopic nephropexy was successful with no intraoperative complications. The mean operative time was 167 minutes, and the mean estimated blood loss was <10 mL in all five patients. The mean convalescence period was 19.6 days. A postoperative urogram with the patients both supine and erect revealed an improvement in renal function, decreased displacement of the kidney (less than one vertebral body), or both. All patients were satisfied with the clinical outcome during an average of 18 months of follow-up. CONCLUSIONS: Retroperitoneoscopic nephropexy is feasible for patients with symptomatic nephroptosis. We recommend nonabsorbable materials such as silk for fixation of the kidney to the psoas or quadratus lumborum muscle.     

Laparoscopic nephropexy: long-term follow-up--Washington University experience

BACKGROUND AND PURPOSE: Recently, laparoscopy has been reported as a minimally invasive approach for performing nephropexy in patients with symptomatic nephroptosis. Herein, we report our long-term follow-up of patients undergoing laparoscopic nephropexy for this indication. PATIENTS AND METHODS: Fourteen women presenting with right flank pain and radiologically documented nephroptosis underwent transperitoneal laparoscopic nephropexy. The hospital data were evaluated for operative time, time to oral intake, time to ambulation, amount of parenteral analgesics, and hospital stay. Pain analog scores and postoperative questionnaires were used to assess the long-term postoperative recovery of the patients. RESULTS: The average operative time was 4.1 hours (range 2.5-6.5 hours). The patients resumed oral intake an average of 16.5 hours (range 15-48 hours) postoperatively. Analgesic requirements averaged 37 mg of morphine sulfate equivalent (range 15-80 mg of morphine equivalent). The average hospital stay was 2.6 days (range 2-5 days). The average follow-up time for the 14 patients was 3.3 years, with an average 80% improvement in their pain (range 56%-100%). On average, the patients resumed their usual activities 6 weeks postoperatively (range 1-12 weeks). CONCLUSION: Nephropexy can be safely and effectively accomplished laparoscopically, with durable radiographic and clinical resolution of the signs and symptoms.     

Case report: Three-trocar technique for bilateral laparoscopic nephropexy

Nephroptosis is a rare syndrome, which affects the right kidney in the majority of cases. In the current report, a case of bilateral nephroptosis with an unusual presentation is presented. We performed bilateral laparoscopic nephropexy using a three-trocar approach. The intervention was successful, with a short operative time and minimal blood loss. The clinical presentation of our patient and the surgical technique for bilateral laparoscopic nephropexy are described.     

Laparoscopic nephropexy: Treatment outcome and quality of life

BACKGROUND: The recent introduction of laparoscopic procedures has markedly altered urological surgery. Laparoscopic nephropexy has attracted the attention of urologists as a treatment for nephroptosis. Herein, we describe our experiences and quality-of-life outcome of laparoscopic nephropexy and discuss its indications and surgical techniques. METHODS: From May 1998 to February 2002, six female patients, ranging in age from 20 to 64 years (median age 39.8 years), with symptomatic nephroptosis underwent laparoscopic nephropexy. Mean preoperative downward kidney displacement was 2.25 vertebral bodies (range 2-2.5) and all affected kidneys were tilted at orthostasis. One patient underwent nephropexy through the transperitoneal approach and the remaining patients underwent nephropexy through the retroperitoneal approach. To evaluate surgical results, postoperative follow-up interview (pain visual analog scale and the short-form 36 (SF-36) health survey questionnaire) and objective examinations were performed. RESULTS: All procedures were accomplished without complication. Postoperative intravenous pyelography correctly confirmed fixed kidney in both supine and erect positions. All patients reported an improvement of symptoms approximately 1 month after nephropexy and no symptoms have recurred during the follow-up period (range 6.3-50.7 months). On the SF-36, two domains, including role limitations due to emotional problems (RE) and mental health (MH), exhibited significant improvement postoperatively (P = 0.0405 and P = 0.0351, respectively). CONCLUSIONS: Laparoscopic, in particular retroperitoneoscopic, nephropexy yields excellent outcomes and greatly improves general health-related quality of life, particularly mental status, as a minimally invasive treatment for symptomatic nephroptosis.     

The use of the tissue adhesive enbucrilate (histoacryl) in the treatment of symptomatic nephroptosis

PURPOSE: To evaluate the use of the tissue adhesive enbucrilate in the treatment of symptomatic nephroptosis. MATERIALS AND METHODS: We performed adhesive nephropexy in 9 patients who presented with well-documented symptomatic nephroptosis that was demonstrated with intravenous pyelography and/or radionuclide renogram studies. The ptotic kidney was fixed on the psoas muscle using 0.5 ml of enbucrilate (Histoacryl). RESULTS: Adhesive nephropexy was successful in all 9 patients. Average operative time was 37 min. Postoperative opioid analgesia duration and hospital stay were limited (mean 2 and 4.4 days, respectively). Most patients returned to normal activity within 2 weeks (mean 14.2 days). Mean follow-up was 25 months and showed postoperatively a good anatomical result in radiographic studies as well as significant pain alleviation (mean 1 vs. 7 preoperatively, on a 10-point scale, p < 0.005 Wilcoxon rank test). CONCLUSIONS: The tissue adhesive enbucrilate seems to be a safe, efficient agent to obtain good results in a simple, quick approach in the surgical treatment of symptomatic nephroptosis.     

Nephropexy ad modum Albarran Marion: long-term follow-up

OBJECTIVE: To report a long-term follow-up of nephropexy ad modum (a.m.) Albarran Marion. MATERIAL AND METHODS: Between 1980 and 1999, 18 women (mean age 42.6 years) underwent nephropexy a.m. Albarran Marion. The duration of symptoms varied from 7 months to 9 years. All patients were examined preoperatively using excretory urography and renography in both the supine and erect positions in order to document renal descent. Patients with decreased renal function also underwent postoperative renography. A questionnaire concerning pre- and post-treatment symptoms was sent to all patients. RESULTS: Hospitalization averaged 7.2 days (range 4-15 days). Pneumothorax occurred in 7 patients, 3 of whom required temporary drainage. One patient developed pneumonia and another a retroperitoneal haematoma; no other complications occurred. All postoperative renography findings were normal. Median follow-up time was 11.2 years (range 2-21 years). At follow-up, 87.5% of patients were satisfied with the results and were free from pain. Two patients were not satisfied with the results; retrospectively the indications for surgery in these 2 cases were not absolute. CONCLUSIONS: Operative treatment for symptomatic nephroptosis should only be performed in selected cases. We present a success rate of 87.5% for nephropexy a.m. Albarran Marion, at a mean follow-up of 11.2 years, which equals the best results obtained with other procedures. The choice of operative procedure for symptomatic nephroptosis must be based on the special interests and skills available at the institutions concerned.     

Retroperitoneoscopic nephropexy for symptomatic nephroptosis

Background: Open nephropexy for nephroptosis creates significant morbidity. We describe our technique for retroperitoneoscopic nephropexy and evaluate its efficacy. Methods: Twenty-five renal units in 23 patients with symptomatic nephroptosis underwent retroperitoneoscopic nephropexy by suturing the posterior renal capsules and transfixing them to the back muscles. The diagnosis and postoperative assessment were made by typical symptoms (via patient questionnaire) and findings of intravenous urography (IVU) when the position was changed from supine to erect. Results: Mean operative time was 188 min (range, 90–330). Mean narcotic use was 15.6 mg morphine. Complete resolution of symptoms occurred in 84% (21/25) renal units; 12% (three of 25) achieved partial improvement (>75% decrease of preoperative symptoms). Follow-up IVU showed that 88% of patients had a renal descent of <2 cm on standing; the others had a descent of 2–4 cm. All of the five renal units with hydronephrosis resolved completely after the operation. Conclusions: This modified technique of retroperitoneoscopic nephropexy is a minimally invasive, feasible, and highly successful option for treating patients with symptomatic nephroptosis.     

Laparoscopic nephropexy for symptomatic nephroptosis: a case report]

We present our clinical findings of laparoscopic nephropexy performed on a 32-year-old woman with symptomatic nephroptosis. Supine and erect excretory urography (DIP) revealed right renal descent of 2.5 vertebral bodies with hydronephrosis. Laparoscopic transperitoneal nephropexy was performed using nonabsorbable sutures, polyglactin net, hernial staplers and tissue adhesive. An upright DIP 1 month postoperatively revealed renal descent of only 1 vertebral body and no hydronephrosis. One year postoperatively, the patient is asymptomatic. A laparoscopic procedure, which is safe, effective and causes minimal morbidity, represents an excellent approach for repair of symptomatic nephroptosis.     

腹膜后腹腔镜肾切除术的临床体会

目的：总结腹膜后腹腔镜肾切除术的手术方法和临床经验。方法：回顾分析腹膜后腹腔镜肾脏切除术治疗各类肾脏疾病患者28例的临床资料,其中肾癌13例,肾盂癌5例,上段输尿管癌3例,肾萎缩6例,肾结核1例。结果：手术均获成功,无手术并发症发生。手术时间80～180min,平均100min;术后8～24h进食,术后住院7～14d。结论：腹膜后腹腔镜肾脏切除手术具有患者损伤小、康复快、住院时间短,对腹腔脏器干扰少等优点,具有良好的临床应用前景。