改良Politano-Leadbetter术治疗儿童原发性输尿管膀胱连接处异常  

MODIFIED Politano-Leadbetter REIMPLANTATION FOR TREATMENT OF CONGENITAL MALFORMATION OF VESICOURETERAL JUNCTION IN CHILDREN

作　　者：曾莉[1] 黄一东[1] 康磊[1] 黄桂珍[1] 袁淼[1] 张跃[1] 张杰[1] 黄鲁刚[1] 

机构地区：[1]四川大学华西医院小儿外科,成都610041

出　　处：《中国修复重建外科杂志》2015年第10期1279-1283,共5页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的 探讨改良Politano-Leadbetter术治疗儿童原发性输尿管膀胱连接处异常的疗效。 方法 回顾性分析2000年6月－2014年10月，采用改良Politano-Leadbetter术治疗的53例原发性输尿管膀胱连接处异常患儿的临床资料。男24例，女29例；年龄8个月-7岁，平均2.1岁。其中输尿管膀胱连接处狭窄23例，左侧狭窄14例、右侧狭窄5例、双侧狭窄4例。膀胱输尿管反流30例，经排尿性膀胱尿道造影证实为Ⅲ度及以上程度反流，其中单侧12例、双侧18例。病程1个月-1年，平均5个月。结果手术均顺利完成，单侧手术时间65-85 min，平均74 min；双侧98-130 min，平均105 min。拔除尿管后无排尿困难发生，无切口感染和裂开发生。53例均获随访，随访时间6个月-14年，中位时间28个月。所有患儿均无尿漏、膀胱输尿管反流、输尿管膀胱连接处梗阻、高血压等并发症发生。术后1个月膀胱镜检查示新输尿管口形态良好。术后3个月复查泌尿系超声示患儿患侧肾积水均减轻。7例患儿（13.2%）术后6个月内发生尿路感染，经抗感染治疗后痊愈。32例术后6个月行排尿性膀胱尿道造影检查，无膀胱输尿管反流复发或持续存在。结论改良Politano-Leadbetter术简化了手术操作，术后纵向走行的输尿管更接近生理状态，手术成功率高，并发症发生率低，尤其适用于单侧巨输尿管迂曲扩张需行输尿管成形者。Objective To explore the effectiveness of modified Politano-Leadbetter reimplantation for the treatment of congenital malformation of the vesicoureteral junction in children. Methods A retrospective analysis was made on the clinical data of 53 patients with congenital malformation of the vesicoureteral junction treated with modified Politano-Leadbetter reimplantation between June 2000 and October 2014. Of 53 cases, there were 24 boys and 29 girls, aged from 8 months to 7 years （mean, 2.1 years）; 23 had congenital vesicoureteral junction obstruction （14 left, 5 right, and 4 bilateral）, and 30 had vesicoureteral reflux （12 unilateral, 18 bilateral）, which were verified by voiding cystourethrography. The disease duration was from 1 month to 1 year （mean, 5 months）. Results All of the patients underwent modified Politano-Leadbetter reimplantation successfully. The mean operation time was 74 minutes （range, 65-85 minutes） for unilateral cases and 105 minutes （range, 98-130 minutes） for bilateral cases. There was no dysuria, infection of incision, or incision dehiscence after urinary catheter removal. The follow-up time was 6 months to 14 years （median, 28 months）; all patients were free from complications of fistula, vesicoureteral reflux, vesicoureteral junction obstruction, or hypertension. The new ureteral orifices had good appearance at 1 month after operation. Urologic ultrasound showed that hydronephrosis relieved at 3 months after operation. Urinary tract infection rate was 13.2% （7/53） during 6 months after operation, which was cured by antibiotics. Voiding cystourethrography showed no vesicoureteral reflux in 32 cases at 6 months after operation. Conclusion The modified Politano-Leadbetter reimplantation simplifies the operation course, which has the longitudinal ureter after operation and is similar to physiological state. It is a safe and effective option for congenital malformation of vesicoureteral junction in children with few complications, especially for patients with un

关 键 词：改良Politano—Leadbetter术 输尿管膀胱再植术 输尿管膀胱连接处狭窄 膀胱输尿管反流 儿童 

分 类 号：R726.9[医药卫生—儿科]