Long-term followup after laparoscopic nephropexy for symptomatic nephroptosis.
Long-term followup after laparoscopic nephropexy for symptomatic nephroptosis.
复制标题
腹腔镜肾固定术治疗症状性肾下垂后的长期随访。
DOI：
10.1016/s0022-5347(05)65961-7
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发表时间：
2001
期刊：
影响因子：
--
通讯作者：
H. Pflüger
中科院分区：
文献类型：
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作者：
E. Plas;Kurosh Daha;C. Riedl;W. Hübner;H. Pflüger
目的：症状性肾下垂是一种罕见的疾病，仅在少数病例中需要手术治疗。腹腔镜肾固定术已被报道为有症状患者的微创治疗方法。我们评估了腹腔镜下同种异体网状移植固定肾脏后的长期疗效。材料与方法自1992年以来，对30例有症状性肾下垂患者行腹腔镜经腹膜肾固定术。所有患者术前均行仰卧位和直立位排泄尿路造影（IVP）和肾裂扫描检查。将肾脏固定在腹壁上分别采用聚乳酸网片和聚丙烯网片移植6例和24例。共有17例患者参与了长期结果评估，随访时间至少为5年。分别采用卧位和站立方式进行临床检查、IVP和劈裂肾功能检查。进一步询问患者术后满意度以及是否会再次接受手术。结果17例患者中，10例完成全部调查，3例电话联系，4例失访。中位随访时间为5.9年。所有病例均有症状改善，其中11例完全缓解，2例不需药物治疗的间歇性侧腹疼痛。1例患者术后无尿路感染、血尿，高血压改善，术后无需药物治疗。10例患者中8例术后未见复发，2例复发性上睑下垂5厘米及以上。使用聚乳酸和聚丙烯网片移植后复发。术前、术后肾碘扫描显示9例患者肾功能明显改善（p <0.05）。两组术后肾功能差异无统计学意义，仅有1例未见改善。除首次手术后3个月有1例症状性复发需要开腹手术固定外，无其他并发症。11例患者对远期疗效完全满意，2例患者对远期疗效一般满意。12例患者将再次接受手术，其中2例伴有持续轻微的侧腹疼痛。一名患者在是否要再次接受手术方面前后矛盾。结论症状性肾下垂是一种非常麻烦的疾病，需要在患者仰卧和直立时进行充分的评估，包括IVP和裂肾扫描。良好的临床效果和满意的美容效果支持腹腔镜肾固定术作为治疗的首选。近期和远期结果均证明同种异体补片肾固定是一种微创治疗方法，成功率高。
PurposeSymptomatic nephroptosis is a rare disease requiring surgical therapy only in select cases. Laparoscopic nephropexy has been reported as minimally invasive treatment for symptomatic patients. We evaluated our long-term outcome after laparoscopic fixation of the kidney with an alloplastic mesh graft.Materials and MethodsSince 1992, 30 patients have undergone laparoscopic transperitoneal nephropexy for symptomatic nephroptosis. All patients were preoperatively investigated by excretory urography (IVP) and split renal scan in the supine and upright positions. For fixing the kidney to the abdominal wall a polyglactin and polypropylene mesh graft was used in 6 and 24 cases, respectively. A total of 17 patients with a minimum followup of 5 years participated in an assessment of long-term outcome. Clinical examination, IVP and split renal function testing were performed with patients lying and standing. Patients were further questioned about postoperative satisfaction and whether they would undergo the procedure again.ResultsOf 17 patients 10 completed all investigations, 3 were contacted by telephone and 4 were lost to followup. Median followup was 5.9 years. Improvement in symptoms was reported in all cases with complete relief in 11 and intermittent flank pain requiring no medication in 2. There were no postoperative urinary tract infections or hematuria observed with improved hypertension requiring no postoperative medication in 1 case. Postoperatively IVP showed no recurrence in 8 of 10 patients but there was 5 cm. or greater recurrent ptosis in 2. Recurrence developed after using the polyglactin and polypropylene mesh grafts. Comparing preoperative and postoperative123iodine renal scans revealed significant improvement in renal function in 9 cases (p <0.05). There was no postoperative difference in split renal function and only 1 patient did not improve. No complications were noted except 1 symptomatic recurrence 3 months after the initial operation that required open surgical fixation. A total of 11 patients were completely satisfied with the long-term outcome and 2 were moderately satisfied. Of the patients 12 would undergo the procedure again, including 2 with persistent slight flank pain. One patient was inconsistent in regard to whether she would undergo the procedure again.ConclusionsSymptomatic nephroptosis is a bothersome disease requiring therapy only after thorough evaluation, including IVP and split renal scan with patients supine and upright. The good clinical outcome and highly satisfactory cosmetic result support laparoscopic nephropexy as the treatment of choice. Short-term and long-term results prove the efficacy of renal fixation with alloplastic mesh graft as minimally invasive therapy with a high success rate.