先天性前尿道瓣膜及憩室对上尿路损害的研究  

Analyze the upper urinary tract impairment made by the congenital anterior urethral valve （ AUV ） and diverticulum.

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

机构地区：[1]首都医科大学附属北京儿童医院外科,100045

出　　处：《临床小儿外科杂志》2010年第6期426-429,共4页Journal of Clinical Pediatric Surgery

摘　　要：目的 比较先天性前尿道瓣膜及憩室对上尿路的损害,分析二者是否同一疾病不同表现的可能,并了解其对上尿路的损害.方法 回顾性分析本院1990年1月至2009年12月收治的先天性前尿道瓣膜（52例）及憩室（26例）患儿临床资料,比较其临床表现、手术方式及术后恢复情况.两组间率的比较采用x2检验,P＜0.05为差异有统计学意义.结果 20例（38.5%）前尿道瓣膜患儿及38例（30.8%）前尿道憩室患儿存在不同程度膀胱输尿管返流,前者20例（38.5%）及后者12例（46.2%）存在上尿路积水.两组在输尿管反流发生率及程度、上尿路积水方面比较,差异无统计学意义（P＞0.05）.前尿道瓣膜患儿存在膀胱憩室和（或）成小梁改变者明显多于前尿道憩室患儿（P＜0.05）.11例前尿道瓣膜及6例前尿道憩室患儿接受了2次或2次以上手术,其中5例行膀胱输尿管再植抗反流.存在输尿管反流的11例前尿道瓣膜和4例憩室患儿获随访,随访时反流消失或不超过3级.结论 本研究中,前尿道瓣膜和憩窒患儿上尿路积水和膀胱输尿管反流情况无明显差异,支持二者是同一疾病不同表现形式的判断.对于存在膀胱输尿管反流的患儿,当下尿路梗阻解除后,若反流仍达4级以上,可以考虑采取抗反流手术.Objective The impairment of upper urinary tract made by the congenital anterior urethral valve （AUV） is compared with the impairment made by the diverticulum. Try to analyze whether these two items are different presentations of the same disease or not and to understand the treatment of upper urinary tract impairment. Methods Medical records of 78 cases （52 with AUV and 26 with diverticulum） treated at Beijing Children＇ s Hospital from 1990 - 2009 are reviewed reirospectively. The clinical presentations, treatments and results are evaluated. Chi-squire test is used in statistic analysis. There is significant difference if the P 〈 0.05. Results Vesicoureteric refluxes （VUR） happened in 20 cases （38.5%） with AUV and 8 （30.8%） with diverticulum. Upper urinary system dilation appeared in 20 cases （38.5%） with AUV and 12（46.2% ） with diverticulum. There is no significant difference in incidence and degree of VUR between cases with AUV and diverticulum. There is no significant difference in upper urinary tract dilation either. The incidence of bladder diverticulum and/or trabeculation presented in cases with AUV is more than in Cases with diverticulum significantly （ P 〈 0.05 ）. 11 cases with AUV and 6 cases with diverticulum received operation twice or more, 5 cases among them got uretero-vesicular reimplantation. VUR disappeared or reduced to ≤3 degree in 11 cases with AUV and 4 cases with diverticulum who were able to be followed up. Conclusions There are no significant differences between patients with AUV and with diverticulum according to the impairment of upper urinary system. The assumption that AUV and diverticulum are different presentations of the same disease is supported. If the urethral obstruction is resolved, uretero-vesicular reimplantation could be applied in patient whose grade of VUR is IV/V.

关 键 词：尿道/畸形 憩室 肾盂积水 

分 类 号：R696[医药卫生—泌尿科学]