小儿下尿路梗阻的球囊扩张治疗  

BALLOON DILATATION FOR LOWER URETHRAL OBSTRUCTION IN CHILDREN

作　　者：李爽[1] 汤凤萍[1] 戴世希[1] 周辉霞[1] 谷龙杰[1] 

机构地区：[1]武汉市儿童医院泌尿外科,武汉430016

出　　处：《中国修复重建外科杂志》2006年第3期238-240,共3页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨球囊导管扩张术治疗小儿下尿路梗阻的临床疗效。方法1990年4月～2004年8月,收治下尿路梗阻患儿26例,年龄18d～12岁,其中后尿道瓣膜23例,前尿道瓣膜2例,外伤性后尿道狭窄1例。术前常规行排尿性膀胱尿道造影确诊。双肾均有不同程度的肾盂及输尿管扩张。术前伴尿潴留及肾功能不良者行尿液引流及纠正电解质紊乱后,再行球囊扩张术。术中采用静脉氯胺酮麻醉,30%泛影葡胺作为球囊扩张剂,应用囊径分别为5、8和10mm,囊长4cm的球囊导管扩张尿道。术后常规留置双腔气囊导尿管。结果23例后尿道瓣膜扩张28次,2例前尿道瓣膜扩张2次,1例后尿道狭窄扩张1次后症状好转改用金属探子扩张治疗后3个月治愈,扩张术中均可见球囊被挤压痕迹消失。术后1周拔管,患儿均排尿通畅,尿线增粗。6例术后1～3个月行膀胱输尿管防返流术返流消失。术后25例获随访1～13年,患儿生长发育良好,排尿通畅,双侧肾积水有不同程度的改善。结论球囊扩张术是小儿下尿路梗阻的一种有效的治疗方法,且安全简便。Objective To evaluate the clinical effect of balloon dilatation in the treatment of lower urinary tract obstruction in children. Methods Twenty-six boys suffering from lower urinary tract obstruction underwent the balloon dilatation operation. These patients included 23 cases of posterior urethral valves, 2 cases of anterior urethral valves and 1 case of traumatic urinary tract stricture. Their ages ranged from 18 days to 7 years. All the patients were diagnosed by voiding cystourethrogram （VCG）. Some of the boys suffered from bilateral hydronephrosis and dilated ureters. Before operation, the patients with urine retention or abnormal renal function should drain urine and correct the disorder of fluid and electrolyte. Balloon dilatation was done after their conditions were improved. During operation, ketamine anaesthesia was used, and 30% diatrizoate melglumine was used as dilatation drug. The balloon catheters which had the length of 4 cm and the diameters of 5,8,10 mm respectively were used for dilating the urethra. After operation, a Foley＇s catheter was routinely indwelled. Results During procedure, compression phenomena disappeared in the course of operation. All the patients urinated normally after catheter was removed at 1 week post operatively. 6 cases received ureteral reimplantation to prevent vesioureteral reflux after 1 to 3 months. 25 patients were followed up from 1 to 13 years and all patients had normal micturition and the bilateral hydronephrosis were improved. Conclusion Balloon dilatation is a safe, effective and feasible therapy for lower urinary tract obstruction in children.

关 键 词：小儿 下尿路梗阻 球囊扩张 

分 类 号：R726.9[医药卫生—儿科]