腹腔镜与开放肾固定术治疗肾下垂的临床研究

目的总结腹腔镜与开放肾固定术治疗肾下垂的疗效。方法自1991-2003年，行腹腔镜肾固定术15例15侧(组1)，腰大肌肌瓣肾固定术12例12侧(组2)。总结两组病例资料及临床疗效。结果腹腔镜组均成功，无中转开放。组1与组2平均手术时间分别为95min(55～190min)和150min(130-200min)，平均出血量35ml(10-100ml)和110ml(80-150ml)，术后镇痛药平均使用量26．7mg(Tramal)和75mg(Tramal)，平均恢复饮食时间15．5h和32h，术后平均住院时间8．5d和15．6d，组1平均随访3．2年(0.5～6.0年)，12例(80％)症状消失，3例(20．0％)症状减轻。组2平均随访8.3年(3～12年)，8例(66．7％)症状消失，4例(33．4％)症状减轻。两组并发症发生率分别为20％(3／15)和16．7％(2／12)。腹腔镜组12例和开放手术组8例患者术后6-8周IVU检查证实手术侧肾脏位置正常。结论腹腔镜肾固定术是症状性肾下垂患者安全有效的治疗方法。

Clinical study of laparoscopic nephropexy and open nephropexy

Objective: To study the clinical effects of laparoscopic nephropexy and open nephropexy. Methods: 15 cases and 12 cases of symptomatic nephroptosis underwent laparoscopic nephropexy or open nephropexy respectively from 1991 to 2003 at our department. Their clinical results and follow-up results were studied and discussed. Results: All the laparoscopic nephropexy were successful and no one was transversed to open nephropexy. For laparoscopic nephropexy, the average operative time was 95 min (range 55~190 min). The average blood lost during operation was 35 ml (range 10~100 ml). Analgesic of Tramal requirements averaged 26.7 mg. The patients resumed oral intake at an average of 15.5 hours. The average hospital stay was 8.5 days. The average follow-up time for the 15 patients was 3.2 years (range 0.5~6.0 years), with a complete relief of symptoms for 12 patients (80%), a partial relief of symptoms for 3 patient (20.0%). For open nephropexy, the average operative time was 150 min (range 130~200 min). The average blood lost during operation was 110 ml (range 80~150 ml). Analgesic of Tramal requirements averaged 75 mg. The patients resumed oral intake at an average of 32 hours. The average hospital stay was 15.6 days. The average follow-up time for the 12 patients was 8.3 years (range 3~12 years), with a complete relief of symptoms for 8 patients (66.7%), a partial relief of symptoms for 4 patients (33.4%). IUV results of 12 patients of laparoscopic nephropexy and 8 patients of open nephropexy showed normal position of kidneys. Conclusion: Laparoscopic nephropexy is safe and effective for selected symptomatic nephroptosis.