Perirenal fascia and psoas muscle suture fixation

Renal ptosis is a common disease, more common in women with weight loss and body length. Men are less common, women are 10 times more than men, children are rare, and the right side accounts for the vast majority. Because the female kidney fossa is small, the periorbital adipose tissue of the thinner is reduced, the congenital renal pedicle is too long, the ligament is slack, and the lack of tension of the abdominal wall muscle after delivery causes the kidney to support fatigue and easily cause the kidney to sag. Chronic cough, constipation, and women wearing high heels make the kidney socket more shallow, which is also the cause of renal ptosis. Normal kidney activity, the standing position and the lying position can differ by 2 to 5 cm. Those who exceed this range are called renal ptosis. According to the degree of renal ptosis, it can be divided into 3 levels. The lower edge of the rib can be the first level, and the kidney can be the second level. The kidney can move in the abdomen to the third level, or it is called the walking. kidney. Some patients with renal ptosis are accompanied by sagging organs of the abdomen, so the ptosis may be a manifestation of total body weakness. Renal ptosis can cause the kidney to move to the longitudinal or transverse axis, causing the kidney pedicle to be pulled or twisted, blocked by renal venous return, leading to renal blood stasis and even kidney atrophy. Distorted ureter leads to poor drainage of the urine, causing hydronephrosis, infection, and stone formation. Acute colic can produce renal colic (Dietl crisis) if there is a sudden distorted kidney pedicle. The degree of renal ptosis is not directly proportional to clinical symptoms. Common symptoms of renal ptosis are low back pain, dull pain, and sometimes cramps after work or walking. After supine, it can be relieved. Such patients may be associated with bloating, acid reflux, indigestion or neurasthenia. Most patients have no symptoms and are often found in abdominal examinations or inadvertently. Patients with renal ptosis can understand the degree of renal sag by B-ultrasound and intravenous pyelography (recumbent position), and determine whether there is hydronephrosis or stone formation, which is helpful for selecting appropriate treatment methods. Most of the patients with renal ptosis do not need surgery. For those who have symptoms without renal pelvis, non-surgical treatment such as proper rest, strengthening nutrition, traditional Chinese medicine, abdominal muscle exercise, use of belt or kidney support, etc. The sclerosing agent or autologous blood can be injected around the kidney to make the kidney adhere to the surrounding tissue to achieve a fixed kidney function. For patients with renal ptosis associated with urinary tract infections, infection should be actively controlled. The above treatments often achieve certain effects. When non-surgical treatment is ineffective, surgical treatment of renal fixation can be used. The choice of various types of renal fixation depends on the specific conditions and conditions of the operator and the patient. There are many procedures for kidney fixation. The purpose of the operation is to loosen the upper part of the renal pelvis and ureter, correct the lesions that cause urinary tract obstruction, fix the kidney in the normal anatomical position, and keep the urine flowing smoothly. To achieve the above objectives, the surgical results are satisfactory. Symptoms of severe or incomplete neurasthenia caused by renal ptosis, although the kidney is well fixed, the surgical results are not satisfactory, and even the symptoms are as before. Therefore, the treatment effect and the choice of surgical indications and the mastery of treatment methods are closely related to the treatment of renal ptosis. The perirenal fascia and lumbar muscle suture fixation were designed by Deming and relied entirely on the perirenal fascia and adipose tissue to fix the kidney. The normal anatomical location of the kidney is shown in the figure below. Treatment of diseases: renal ptosis Indication Perirenal fascia and lumbar muscle suture fixation are applicable to: 1. The symptoms of renal ptosis are severe, affecting work, and the symptoms are relieved after supine, and the symptoms are not alleviated by non-surgical treatment. 2. Renal ptosis with complications such as hydronephrosis, obvious hematuria, stones, long-term urinary tract infection, non-surgical treatment can not work. 3. Severe renal ptosis, causing distortion of the renal vascular pedicle and ureter, and symptoms of colic. Contraindications 1. The symptoms of the kidney are not relieved after supine, and the relationship with the body position is not great or the renal ptosis is accompanied by neurasthenia or visceral sag. 2. Mild renal ptosis, symptoms are not obvious and the kidney has no obvious pathological changes. Preoperative preparation 1. Before surgery, you should know the condition and comprehensive examination in detail, and determine the degree of renal ptosis, whether there is urinary calculi, hydronephrosis, urinary tract infection. 2. When there is a urinary tract infection, apply antibiotics to control the infection. 3. Strengthen supportive care and improve the general condition. Surgical procedure 1. Incision and exposure of the kidney The 12th rib undercut at the waist. Cut the skin and subcutaneous tissue along the direction of the incision, cut the latissimus dorsi, the posterior inferior serratus and the external oblique muscle, cut the lumbar ligament upward, cut the intra-abdominal oblique muscle downward, and then cut the transverse fascia. Open the fascia and expose the kidneys. During the operation, be careful not to damage the peritoneum, and repair if damaged. Keep the renal fascia relatively intact. 2. Free kidney and upper ureter After the kidney is exposed, it is bluntly separated by the finger along the surface of the renal capsule, and the ligation should be cut when the fiber is taken. Small blood vessels should also be ligated to stop bleeding. During the operation, attention should be paid to the supply of the vagus blood vessels of the kidney. Do not blindly cut off, so as to avoid partial necrosis of the kidney. Carefully peel off the nerve fibers around the renal artery. After freeing, the adipose tissue on the surface of the kidney capsule is removed as much as possible. Using the same method as above to free the upper ureter, the ureter can not be stripped too much to prevent ureteral ischemia. After the kidney and ureter are free, it is required to return to the normal anatomy without tension, and correct the lesions such as obstruction. 3. Fix the kidney After the kidney and the upper ureter are free, the kidney is returned to the normal position, and the perirenal fascia and the psoas muscle are sutured horizontally in the lower pole of the kidney to hold the kidney. The first needle sutured the perirenal fascia to the lumbar muscle 1 cm outside the ureter, as high as possible. Then, depending on the situation, the perirenal fascia and the psoas muscle are sutured 4 to 7 stitches on the outside of the first needle, and the position is suitable for the first needle. The suture is not tied. Check the kidney resettlement and be careful to prevent the ureter from being sewn or compressed. Confirmed that the renal reduction was satisfactory, the ureter was not angled, twisted, and compressed, the suture was tightened, and the kidney was knotted from the inside to the outside to fix the kidney. 4. Close the incision After the kidney is fixed, check for bleeding and place drainage if necessary. The incision was sutured layer by layer according to the surgical incision level. complication The main complication after surgery was recurrence of renal sag and failure of surgery. The reason may be that the case is not properly selected, the surgical technique is wrong, the accompanying pathological changes are not corrected, the kidney and ureter are not completely free, and the position of the kidney is not correct. The most common mistake is that the cause of pain in the kidney area is not really understood, and there is a rotation when the kidney is fixed. As long as the surgery is treated as required, the postoperative results are satisfactory.

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