迷走血管压迫致梗阻性肾积水34例临床分析  

Ureteropelvic junction obstruction by crossing renal vessels in children.

作　　者：宋宏程[1] 白继武[1] 黄澄如[1] 孙宁[1] 张潍平[1] 田军[1] 谢向辉[1] 李明磊[1] 李宁[1] 

机构地区：[1]首都医科大学附属北京儿童医院泌尿外科,100045

出　　处：《临床小儿外科杂志》2009年第6期3-5,共3页Journal of Clinical Pediatric Surgery

摘　　要：目的探讨小儿肾盂输尿管交界部迷走血管压迫致梗阻性肾积水的临床特点及治疗方法。方法回顾性分析1997年1月至2008年6月本院收治的34例迷走血管压迫性肾积水患儿的临床资料。结果34例中，男30例，女4例，左侧28例，右侧6例。平均发病年龄9．5岁。手术方法为离断性肾盂成型术（Anderson—Hynes术式），术中同时将迷走血管移向肾盂后方。病理检查证实12例合并肾盂输尿管交界部狭窄，术后半年行IVP复查，积水缓解，症状消失。结论小儿肾盂输尿管交界部迷走血管压迫致梗阻性肾积水发病年龄较大，腹痛明显，积水较轻。治疗上在采取离断性肾盂成刮术的同时，应将迷走血管转移到肾盂输尿管交接部的后方。马蹄肾合并肾积水时迷走血管压迫是主要的发病原因。Objective To investigate the clinical characteristic and treatment of ureteropelvic junction obstruction （UPJO） by crossing renal vessels in children. Methods Between January 1997 to June 2008, there were 1 251 children underwent surgery for UPJO. In 34 children （male 30 and female 4, age rage 5 to 16 years, mean 9.5 years） the obstruction was caused by crossing renal vessels. The data collected from the medical records of these patients were analysed for their clinical presentation and imaging findings. Results The crossing renal vessels were on the left side in 28 cases, only 6 children were on the right side. Duration of symptoms varied from 2 month to 3 years （mean I year and 6 months）. The most common presenting symptoms were intermittent abdominal pain in 28 patients, incidental diagnosis in 4 and 2 was detected prenatally. All pattens had a diagnosis of UPJO through Ultrasound and intravenous pyelography （IVP）. Only one child was found the crossing vessel by retrograde pyelography because the hydronephrosis was very mild. In the patients 10 children associated with horse shoe kidney （There were 19 hydronephrosis associated with horse shoe kidney at the same period）, All patients underwent Anderson-Hynes dismembered pyeloplasties after repositioning the renal pelvis and ureter anteriorly to the crossing renal vessel. 12 patients were suggested intrinsic obstruction besides the crossing renal vessel by microscopically.IVP indicated hydronephrosis reduced after the operation 6-12 months. During the follow-up no patient had an episode of renal colic. Conclusions Crossing renal vessels is a rare cause of nreteropelvic junction obstruction, but it is a main etiology in horseshoe kidney associated with hydronephrosis. Ureteropelvic junction obstruction should be suspected in older children presenting with recurrent renal colic and hydronephrosis. The operation shoud be dismembered Anderson-Hynes pyeloplasty with pelvi-ureteic re-anastomosis anterior to the offending vessels other than only by

关 键 词：肾迷走血管 肾盂输尿管梗阻/外科学 肾积水 

分 类 号：R692.704[医药卫生—泌尿科学] R692.2[医药卫生—外科学]