106例儿童完全型重复肾输尿管畸形的诊治经验  

CLINICAL EXPERIENCE IN DIAGNOSIS AND MANAGEMENT OF COMPLETE DUPLICATION OF KIDNEY AND URETER IN 106 CHILDREN

作　　者：曾莉[1] 黄桂珍[1] 张杰[1] 康磊[1] 黄一东[1] 袁淼[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11期1408-1414,共7页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨儿童完全型重复肾输尿管畸形的临床分类标准及治疗方案。方法回顾分析2000年3月-2015年2月收治的106例完全型重复肾输尿管畸形患儿临床资料。其中男11例,女95例;年龄1个月-11岁,平均3.5岁。单侧88例,双侧18例。根据患儿影像学检查结果和临床表现,按照自定分类标准分为4类：第1类14例,未作特殊处理;第2类15例,行重建吻合术;第3类74例,手术切除发育不良肾段以及引流该肾段的输尿管;第4类3例,选择患侧全肾切除以及患侧输尿管大部分切除治疗。结果 106例患儿均获随访,随访时间2个月-14年,中位时间23个月。第1类患儿病情无进展。第2、3、4类患儿术后均无漏尿、腰肋部不适、排尿时阴部包块突出、生殖道感染、血尿等并发症发生;血常规、肾功能及电解质未见异常。7例出现输尿管残端综合征,其中第2类1例、第3类6例;4例出现尿路感染,其中第2类1例、第3类3例;3例术后残留轻度肾段积水,均为第2类。结论根据完全型重复肾输尿管畸形的临床分类,选择个体化治疗方案,能最大程度保留有效肾单位,提高患儿生活质量,获得较好疗效。Objective To discuss the clinical classification and treatment protocols of complete duplication of kidney and ureter in children. Methods Between March 2000 and February 2015, 106 children with complete duplication of kidney and ureter were treated, and the clinical data were retrospectively analyzed. Of them, there were 11 boys and 95 girls, aged from 1 month to 11 years（mean, 3.5 years）; one side was involved in 88 cases and two sides in 18 cases. They were divided into 4 types according to image examinations and clinical presentations： 14 patients who needed no special treatment were classified into the first type, 15 patients who underwent reconstruction into the second type, 74 patients who underwent segment removal of renal dysplasia and subtotal excision of abnormal duplicated ureter into the third type, and 3 patients who underwent removal of the whole affected kidney and subtotal excision of whole ureter into the forth type. Results The patients were followed up 2 months to 14 years（median, 23 months）. There was no deteriorating case in the first type. There was no complication such as leakage of urine, discomfort over the back and loins, ureterocele, reproductive tract infection, or hematuresis in the other types. The results of white blood cell count, renal function, and electrolyte presented no abnormality. One patient in the second type and 6 patients in the third type had ureteral stump syndrome; 1 patient in the second type and 3 patients in the third type had urinary tract infection; and 3 patients in the second type had mild hydronephrosis after operation. Conclusion It can obtain good clinical outcome to choose individualized treatment according to clinical classification of complete duplication of kidney and ureter, which can reserve effective renal units as much as possible and improves the patients＇ quality of life.

关 键 词：重复肾输尿管畸形 输尿管残端综合征 肾积水 输尿管异位开口 输尿管囊肿 输尿管狭窄 儿童 

分 类 号：R726.9[医药卫生—儿科]