儿童重复肾上肾输尿管膨出合并下肾膀胱输尿管反流的治疗体会  

Therapeutic experiences of duplex system ureterocele with concurrent ipsilateral lower renal pole moiety of vesicoureteral reflux in children

作　　者：方一圩 宋宏程[1] 孙宁[1] 张潍平[1] 田军[1] 李明磊[1] 黄澄如[1] Fang Yiwei;Song Hongcheng;Sun Ning;Zhang Weiping;Tian Jun;Li Minglei;Huang Chengru(Department of Urology,Beijing Children's Hospital,Capital Medical University,National Center for Children's Health,Beijing 100045,China)

机构地区：[1]国家儿童医学中心,首都医科大学附属北京儿童医院泌尿外科,100045

出　　处：《中华小儿外科杂志》2020年第7期591-595,共5页Chinese Journal of Pediatric Surgery

摘　　要：目的:探讨儿童重复肾上肾输尿管膨出合并下肾或对侧肾膀胱输尿管反流合理的治疗方法。方法:回顾分析2007年10月至2019年10月首都医科大学附属北京儿童医院收治的重复肾上肾输尿管膨出合并下肾或对侧肾膀胱输尿管反流24例患儿的临床资料。其中,男5例,女19例,就诊年龄7个月至9岁,平均2岁。重复肾左侧13例,右侧6例,双侧5例,上肾输尿管膨出左侧15例,右侧9例,无双侧,合并下肾膀胱输尿管反流左侧13例,右侧9例,下肾及对侧2例。泌尿系统感染17例,影像学检查发现6例,间断腹痛1例。上半肾无功能者22例行重复肾上半肾切除术;上半肾积水但有功能者2例,行上下输尿管吻合术1例,行上肾输尿管膨出切除上下输尿管膀胱再植术1例。结果:22例半肾切除患儿中19例患儿获得随访,3例失随访,术后下半肾反流消失11例(含对侧反流1例),减轻3例,反流无缓解无临床表现2例(术前Ⅳ级随访4个月,术前Ⅴ级随访2年),3例术后反流未消失合并泌尿系统感染再次手术治疗后治愈。保留上肾2例中,行上下输尿管吻合者术后4个月,无临床症状,尚未复查排尿性膀胱尿道造影,行上肾输尿管膨出切除上下肾输尿管膀胱再植术后复查反流消失无临床症状。结论:重复肾上肾输尿管末端膨出合并下肾或对侧肾膀胱输尿管反流上半肾发育不良无功能多见,上半肾无功能时行上半肾切除,术后11例下半肾反流消失,3例因反流未消失反复泌尿系统感染再次行手术。上半肾功能良好者行保留上半肾行输尿管端侧吻合术或膀胱输尿管再植术。Objective To explore the optimal treatment of children with ureterocele of upper pole moiety of duplex system with concurrent ipsilateral lower renal pole moiety or contralateral renal vesicoureteral reflux.Methods Retrospective analysis was conducted for clinical data of 24 children with ureterocele of upper pole moiety of duplex system with concurrent ipsilateral lower renal pole moiety or contralateral renal vesicoureteral reflux from October 2007 to October 2019.There were 5 boys and 19 girls with an average age of 2 years.The involved sideness of duplication was left(n=13),right(n=6)and bilateral(n=5).Ureterocele of upper pole moiety of duplex system was left(n=15),right(n=9)and bilateral(n=0).Ipsilateral lower pole moiety of renal vesicoureteral reflux was left(n=13)and right(n=9);ipsilateral lower pole moiety and contralateral renal vesicoureteral reflux(n=2).Six children were diagnosed based upon abnormal ultrasound,17 cases presented with urinary tract infection(UTI)and 1 case had intermittent abdominal pain.Twenty-two children with non-functional upper renal pole moiety underwent heminephrectomy.For two cases with functional upper kidneys,upper and lower ureteral anastomosis(n=1)and excision of ureterocele with reimplantation(n=1)were performed.Results Among 22 patients with heminephrectomy,19 were followed up and 3 were lost to follow-ups.Reflux disappeared(n=11),relieved(n=3)and stayed symptom-free(n=2).Three cases were re-operated for urinary tract infection because of non-relieving reflux.One case of upper/lower ureteral anastomosis had no clinical symptoms at 4 months.Reflux disappeared after an excision of ureterocele with reimplantation.Conclusions For non-functional upper renal pole moiety with dysplasia after heminephrectomy,reflux disappeared in most cases and few required reoperation due to urinary tract infection of recurrent reflux.Functional upper kidney might be preserved.

关 键 词：肾疾病 重复肾 输尿管膨出 膀胱输尿管反流 儿童 

分 类 号：R726.9[医药卫生—儿科]