儿童双侧肾盂输尿管交界处梗阻性重度肾积水的诊治分析  

Diagnosis and treatment analysis of severe hydronephrosis induced by bilateral ureteropelvic junction obstruction

作　　者：刘鑫[1] 刘舸[1] 杨屹[1] 侯英[1] 陈辉[1] 牛之彬[1] 

机构地区：[1]中国医科大学附属盛京医院小儿泌尿外科,辽宁沈阳110004

出　　处：《实用医院临床杂志》2016年第4期39-43,共5页Practical Journal of Clinical Medicine

摘　　要：目的 探讨儿童双侧肾盂输尿管交界处梗阻性重度肾积水的诊断与处理方法。方法 2011年11月至2015年2月我院收治的双侧肾盂输尿管交界处梗阻性肾积水患儿19例（共38侧患肾）,手术方式为开放式离断式肾盂输尿管成型术（Anderson-Hynes）,手术均为分次完成,优先进行肾积水程度较重侧别的手术。并进行临床随访,随访期间利用彩超观察肾脏形态恢复情况,以及双肾放射性核素检查观察肾脏功能恢复情况。结果 38侧患肾中共30侧患肾接受了手术,其中9例双侧均进行了手术,双侧手术非同时进行,手术间隔时间33~181天;8例患儿一侧术后对侧积水减轻,未再进行手术;2例患儿一侧术后对侧积水程度一过性减轻,又再次加重,分肾功能降低,再行手术治疗;2例患儿一侧术后对侧积水无明显变化,分肾功能无下降,暂保守观察。比较11例一侧手术后对侧未好转侧和7例一侧手术后对侧好转侧的病例资料发现：好转侧肾积水以SFU3度为主,未好转侧肾积水以SFU4度为主;好转侧肾盂前后径与肾实质厚度的比值低于未好转侧（P〈0.05）。结论对于双侧肾盂输尿管交界处梗阻性重度肾积水的患儿,在进行一侧肾盂输尿管成形术后,对侧的SFU3、SFU4级的肾积水可能会自发性减轻。因此,双侧肾盂输尿管交界处梗阻性重度肾积水的患儿的第二次手术时间可以推迟至第一次手术术后2月左右。Objective To investigate the diagnosis and management of severe hydronephrosis induced by bilateral ureteropel -vic junction obstruction （UPJO） in children.Methods We retrospectively evaluated the records of 19 patients with severe hydrone-phrosis treated n from November 2011 to February 2015 in our institution.The Anderson-Hynes operation was performed in all patients with staged approaches .The patients were followed up .During the period of follow-up,ultrasonography and radionuclide renal scans were used to evaluate the recovery of renal function .Results Of 38 sides of kidneys ,30 sides received operation treatment .Of these pa-tients,9 cases had bilateral operations .However,the bilateral operation was not performed at the same time .The surgery interval time was 33 to 181 days.There were 8 children without further operation when their opposite hydronephrosis was reduced after one side oper -ation.Two children had to suffer the second operation because their hydronephrosis was aggravated again and differential renal function （ DRF） was decreased after opposite hydronephrosis was transiently reduced after one side operation .Two children underwent conserva-tive treatment in view that their DRF was not decreased although their one side hydronephrosis was not changed after opposite opera -tion.We found that the improved hydronephrosis was graded 3 according to the Society for Fetal Urology （ SFU） while the non-improved was grade 4 after comparison of corresponding data .The ratio between anterior/posterior diameter of renal pelvis and thickness of renal parenchyma in the improved cases was lower than that in non-improved patients （ P〈0.05 ） .Conclusion In children with severe bi-lateral UPJO,the non-operated renal units with grade 3 and some with grade 4 hydronephrosis are improved spontaneously after unilater-al pyeloplasty.Therefore,delayed pyeloplasty of the opposite side should be considered for 2 month following initial pyeloplasty .

关 键 词：肾盂输尿管连接处梗阻 双侧 肾积水 

分 类 号：R726.9[医药卫生—儿科]