小儿先天性双肾积水35例临床分析  

Bilateral congenital hydronephrosis in children:clinical analysis of 35 cases

作　　者：张恒[1] 卢根生[1] 李新[1] 沈文浩[1] 熊恩庆[1] 方强[1] 宋波[1] 周占松[1] 

机构地区：[1]第三军医大学西南医院全军泌尿外科研究所,重庆400038

出　　处：《局解手术学杂志》2013年第1期36-37,共2页Journal of Regional Anatomy and Operative Surgery

摘　　要：目的探讨小儿先天性双肾积水的发病机制及治疗策略。方法回顾分析35例小儿先天性双肾积水的尿动力学、泌尿影像、肾脏功能检查及外科治疗的临床资料。结果下尿路排尿功能障碍32例,上尿路梗阻3例;25例残余尿量超过100mL,28例膀胱储尿期压力大于40 cmH2O。16例行后尿道瓣膜切除术;10例神经源性膀胱行自身清洁导尿及骶神经电刺激治疗,4例行精阜切除术,2例行包皮环切术,1例双侧肾盂输尿管交界部狭窄行离断成形术,2例行输尿管膀胱再植术。术后随访6个月以上,双肾积水均明显好转。结论下尿路排尿障碍致膀胱压力超过安全压力仍继续储尿导致双肾积水主因,将膀胱压降至安全压以下是治疗和预防双肾积水的根本措施。Objective To explore the mechanism and therapy of bilateral congenital hydronephrosis in children.Methods The medical history,radiographic studies,urodynamic results and therapies of 35 children were analyzed retrospectively.Results Among the 35 patients with bilateral hydronephrosis,32 cases were lower urinary tract dysfunction and 3 cases were upper urinary tract obstruction,residual urine volume of 25 cases exceed 100 mL and bladder storage pressure of 28 cases were more than 40 cmH2O.The 16 cases with posterior urethral valve accepted valvectomy,10 cases with neurogenic bladder treated by self-cleaning catheterization and sacral nerve stimulation,4 cases accepted colliculectomy,2 cases with phimosis accepted circumcision,1 case with bilateral ureteropelvic junction stenosis accepted ureteropelvic stricture plasty,2 cases with bilateral lower ureteral obstruction received ureterovesical reimplantation.All patients were followed up for more than six months and found hydronephrosis significantly alleviated.Conclusion Vesical pressure over safe pressure result from lower urinary tract voiding dysfunction is the most common reason of bilateral congenital hydronephrosis in children.To depress the vesical pressure until lower than the safe pressure in time is crucial for the treatment of patients with bilateral congenital hydronephrosis.

关 键 词：肾积水 下尿路 排尿障碍 尿动力学 

分 类 号：R692.2[医药卫生—泌尿科学]