儿童输尿管开口异位并肾脏畸形的诊疗分析  

Diagnosis and treatment of ectopic ureter with renal malformation in children

作　　者：周广伦[1] 尹鉴淳[1] 刘晓东[1] 文建国[2] 李守林[1] ZHOU Guanglun;YIN Jianchun;LIU Xiaodong;WEN Jianguo;LI Shoulin(Department of Urology,Children s Hospital of Shenzhen,Shenzhen 518034;The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]深圳市儿童医院泌尿外科,广东深圳518034 [2]郑州大学第一附属医院,河南郑州450052

出　　处：《现代泌尿外科杂志》2021年第3期206-208,225,共4页Journal of Modern Urology

基　　金：深圳市三名工程(No.SZSM201612013)。

摘　　要：目的 探讨儿童输尿管开口异位并肾脏畸形的诊治策略。方法 回顾分析深圳市儿童医院2014年1月至2019年8月收治的68例输尿管开口异位并肾脏畸形患儿的临床资料,通过记录其临床症状、辅助检查、治疗方案和随访资料,总结本病的主要临床表现,探讨如何选取各项术前检查,分析不同手术方式治疗该病的适应证及其术后疗效。结果 临床表现以尿失禁(55例)最常见,另有会阴部湿疹26例、尿路感染24例。术前影像学诊断合并患侧重复肾49例,43例因重复肾功能差行腹腔镜半肾输尿管切除术,6例重复肾功能良好行输尿管膀胱再植术;16例合并同侧肾发育不良,行腹腔镜发育不良肾切除术;肾脏功能正常2例、肾积水并输尿管扩张1例行输尿管膀胱再植术。随访时间平均17.6个月,术后54例(54/55)患儿尿失禁消失,1例术后有急迫性尿失禁,经综合治疗逐渐好转。结论 本病表现以尿失禁最常见,泌尿系造影和肾核素显像可明确患侧肾输尿管形态及功能。腹腔镜半肾输尿管切除与输尿管膀胱再植术是该病主要治疗方法,术后中远期疗效确切。Objective To explore the clinical diagnosis and treatment of ectopic ureter with renal malformation in children.Methods Clinical data of 68 cases treated during Jan.2014 and Aug.2019 at Children s Hospital of Shenzhen were retrospectively analyzed.The clinical manifestations,auxiliary examinations,therapeutic regimes and outcomes,indications and follow-up data were recorded.Results Urinary incontinence(55 cases)was the most common clinical manifestation,followed by eczema(26 cases)and urinary tract infection(24 cases).Preoperative imaging showed renal duplication in 49 cases,43 of whom underwent laparoscopic heminephroureterectomy,and 6 received ureteral reimplantation.Renal dysplasia was observed in 16 cases,who underwent laparoscopic nephrectomy.Preoperative imaging also showed 2 cases with normal kidney,and 1 case with hydronephrosis and ureteral dilatation,who received ureteral reimplantation.During the follow-up of 17.6 months,urinary incontinence was cured in 54 cases,and urgent urinary incontinence occurred in 1 case was improved after comprehensive treatment.Conclusion Urinary incontinence is the most common manifestation of ectopic ureter with renal malformation.Urography and renal radionuclide imaging can reveal the shape and function of ureters.Laparoscopic heminephroureterectomy and ureteral reimplantation are the main treatment for this disease,and the prognosis is good.

关 键 词：输尿管异位开口 肾脏畸形 儿童 诊断 治疗 

分 类 号：R699.4[医药卫生—泌尿科学]