小儿先天性肾盂输尿管连接处梗阻所致肾积水的诊断和治疗  

THE DIAGNOSIS AND TREATMENT OF CONGENITAL URETEROPELVIC JUNCTION OBSTRUCTION IN CHILDREN

作　　者：宋淑敏[1] 刘铭[1] 

机构地区：[1]泸州医学院附属医院小儿外科,四川泸州646000

出　　处：《泸州医学院学报》2010年第3期276-279,共4页Journal of Luzhou Medical College

摘　　要：目的:探讨小儿先天性肾盂输尿管连接处梗阻(UPJO)所致肾积水的诊断和治疗方法。方法:回顾分析2003年12月至2009年6月收治的UPJO所致的肾积水患儿69例临床资料。全部69例经过B超筛查提示UPJO诊断,肾盂积水均>2cm,再行静脉肾盂造影(IVP)检查进一步证实,对未显影的4例和虽肾盂显影而输尿管未显影的6例行输尿管逆行插管造影而确诊。62例单侧肾积水中55例采用一期离断式肾盂输尿管成形术,7例因重度肾积水先行患肾穿刺造瘘引流3～6月,5例再行肾盂输尿管成形术,2例肾切除。7例双侧肾积水中4例1次完成双侧肾盂输尿管成形术,3例分次完成,其中2例一侧肾穿刺造瘘引流3～6月后再行肾盂输尿管成形术。结果:67例74只肾积水均为肾盂输尿管连接处狭窄所致,输尿管瓣膜3例。术后B超随访,均示积水消失或不同程度改善,肾盂前后经缩小,肾实质增厚;33例37只肾术后获得IVP随访,均证实肾盂输尿管吻合口通畅,且术后肾盂显影时间明显较术前提前。结论:B超为肾盂输尿管连接处梗阻诊断最常用的筛查方法,IVP和必要的膀胱镜检输尿管逆行插管是确诊小儿UPJO肾积水的可靠方法,Anderson-Hynes离断式肾盂整形术为UPJO手术"金标准"。Objective：To discuss the diagnosis and treatment of hydronephrosis caused by congenital ureteropelvic junction obstruction in children.Methods： 69 cases of hydronephrosis caused by congenital ureteropelvic junction obstruction in children from December 2003 to Jun 2009 were collected.All of the children underwent ultrasound scan as an initial diagnostic method,then underwent intravenous pyelography .The width of pelvis was bigger than 2 cm in all cases .Cystoscopic examination and successful ureteral regressive intubated visualization were applied in 4 cases with negaative IVP results ,and in 6 cases with positive pyelography but negative ureteralgraph. 55 of the 62 children with a singal affected kidney were initially underwent Anderson-Hynes Dismembered pyeloplasty ,5 children were finally underwent Anderson-Hynes Dismembered pyeloplasty after renelostomy drainage for 3-6 months and 2 children underwent renelostomy. 4 of the 7 children with two affected kidneys were underwent Anderson-Hynes Dismembered pyeloplasty by one time and 3 children by two times after renelostomy drainage for 3～6 months. Results： 74 ureteropelvic junction stenosis and 3 ureteral were demonstrated in the intraoperative and pathological finding.All cases were followed up by ultrasonic examination for 6 months 5 years .The hydronephrosis had been improved ,the width of pelvis decreased and the thickness of renal parenchyma increased. The patency of the anastomosis could be found in 33 children with 37 affected kidneys during follow-up through IVP . Conclusion： Ultrasound scan ,IVP and cystoscopic detection were effective and reliable diagnostic method for the UPJO hydronephrosis.Anderson-Hyne pyeloplasty was the gold standard surgical technique.

关 键 词：小儿 肾盂输尿管梗阻 诊断 外科手术 

分 类 号：R726.9[医药卫生—儿科]