Заболевание нефроптоз: классификация и частота возникновения

Нефроптоз – патологическое состояние, когда почка оказывается смещенной из своего ложа, расположена ниже, чем при физиологической норме, а подвижность почки при изменениях положения тела (особенно в положении пациента стоя)  превышает границы физиологической нормы. Отсюда происходит и синонимы названия этого заболевания – опущение почки, патологическая подвижность почки.

Частота

У женщин, в отличие от мужчин, нефроптоз наблюдается чаще в 5-10 раз и  преимущественно определяется справа. Если превалирование нефроптоза у женщин объяснимо особенностями конституции женщин: более широким тазом, снижением тонуса брюшного пресса после беременности и родов, то правосторонняя локализация – более низкой физиологическим положением почки справа и прочным связочным аппаратом почки слева. В настоящее время у пациентов возраста 25-40 лет нефроптоз выявляется у 1,5 % пациенток. У мужчин такой показатель составляет  0,1%.

Этиопатогенез

В фиксации почки на физиологически-нормальной высоте принимают участие брюшные связки, почечное вместилище, которое образовано фасциями,  диафрагмой и мышцами стенки брюшной полости; фасциально-жировой аппарат почки. Опущение почки обусловливается в основном изменениями  связочного аппарата почки.

Существенную роль в поддержании почки играет фиброзная капсула почки. Она плотно соединена с лоханкой почки и переходит на почечную ножку, сливаясь с сосудистым влагалищем. Жировая капсула имеет существенную роль в фиксации почки на должной высоте: уменьшение объема этой капсулы может привести к  нефроптозу и ротации почки с перекрутом почечной ножки. Физиологическое положение почки обеспечивают также  фасции почки и  соединительнотканные тяжи, прикрепляющиеся в области верхнего полюса. Основную поддерживающую роль играет часть фиброзных волокон капсулы почки, входящих входит в состав фасциального листка ножек диафрагмы.

Развитию нефроптоза способствует ряд факторов: они способны приводить к изменениям  в связочно-поддерживающем аппарате почки. Главными из таких факторов считаются  инфекционные болезни, а также последствия резкого похудания и снижения мышечного тонуса стенки брюшной полости. Травма также может иметь роль в возникновении нефроптоза: в результате гематомы в верхнем полюсе почки или при разрыве связок, полученных при травме, почка может выходить из своего ложа.

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