儿童原发性肾积水的影像学诊断和治疗  

Diagnostic imaging and management for primary hydronephrosis in childhood

作　　者：何蓉[1] 赵海腾[1] 孙杰[1] 陈其民[1] 施诚仁[1] 

机构地区：[1]上海交通大学医学院附属新华医院上海儿童医学中心外科,上海200127

出　　处：《临床泌尿外科杂志》2007年第6期432-434,共3页Journal of Clinical Urology

摘　　要：目的:探讨儿童原发性肾积水的影像学诊断和治疗方法。方法:收集1999年4月～2006年9月收治的原发性肾积水患儿80例,临床主诉以腹痛或腰痛为主。80例均经过B超筛查,再行静脉肾盂造影(IVP)检查31例次,排泄性尿路造影检查3例次,逆行上尿路造影2例次,肾脏同位素检查(ECT)70例次,核磁共振尿路成像(MRU)38例次,并有1例同时进行了动态增强核磁共振尿路成像(Gd-MRU)检查。69例72侧进行了离断式肾盂整形术,其中5例在B超引导下行经皮穿刺肾造瘘术,4例行肾盂输尿管内引流术,3例因重度积水且肾发育不良行肾切除术,7例暂且随访观察。结果:手术及病理检查诊断52侧为肾盂输尿管连接处狭窄,8侧为高位输尿管,3侧为迷走血管压迫,6侧为肾盂输尿管连接处息肉或黏膜乳头样增生,3侧为肾血管或下腔静脉压迫肾盂输尿管交界处。结论:原发性肾积水临床病因以肾盂输尿管连接处梗阻(UPJO)最为多见,影像学以B超为最初筛查方法,IVP和ECT为公认的诊断UPJO时评价病肾形态功能的必需检查方法,但MRU有望替代B超和IVP而成为泌尿系影像学诊断的新"金标准"。在MRU基础上提出Gd-MRU技术可同时评定肾形态及功能,有很好的应用前景。Anderson-Hynes离断式肾盂整形术为UPJO手术"金标准"。Objective：Our aim was to introduce the experience in diagnostic imaging and management for primary hydronephrosis in childhood. Methods： We collected 80 cases of primary hydronephrosis in children from April 1999 to September 2006. All of them underwent ultrasound scan as initial diagnostic methond, then some of them underwent intravenous pyelography, MR urography, radionuclide renography, MR-Gd and so on. 72 renal units underwent Anderson-Hyne pyeloplasty , the rest were treated with pelviostomy or nephrectomy or conservation. Results： lntraoperative and pathological findings demonstrated that ureteropelvic junction stenosis was the main cause of primary hydronephrosis. Conclusions：For long time, Us,IVP and ECT had been used for hydronephrosis as main imaging tools. MRU has the potietial to raplace traditional diagnostic imagings as new gold standard in future. Anderson-Hyne pyeloplasty is the gold standard surgical technique.

关 键 词：肾积水 影像学 外科手术 

分 类 号：R692.2[医药卫生—泌尿科学]