腹腔镜重建性手术治疗小儿不完全型重复肾远端输尿管Y型异位开口合并尿失禁  

Laparoscopic reconstructive operation in the treatment of distal ureteral Y-shaped ectopic orifice with urinary incontinence in children with incomplete duplex kidney

作　　者：陈海涛 马慧 李爽[1] Chen Haitao;Ma Hui;Li Shuang(Department of Urology,Wuhan children's Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology,Hubei 430016,China)

机构地区：[1]华中科技大学同济医学院附属武汉儿童医院泌尿外科,湖北430016

出　　处：《中华腔镜泌尿外科杂志（电子版）》2021年第6期530-534,共5页Chinese Journal of Endourology(Electronic Edition)

摘　　要：目的探讨腹腔镜重建性手术治疗小儿不完全型重复肾远端输尿管Y型异位开口合并尿失禁的疗效。方法回顾性分析本院收治的1例小儿双侧不完全型重复肾远端输尿管Y型异位开口合并尿失禁患儿临床病例资料,患儿,女性,6个月,因“漏尿伴反复发热6个月”入院。行CT检查:双侧重复肾输尿管畸形;双重复肾肾盂积水,双侧重复输尿管扩张迂曲;右侧下组肾积水及右侧输尿管扩张明显,并双侧重复输尿管异位开口可能。经外阴输尿管异位开口逆行插管造影检查:右侧重复肾及输尿管积水,右侧重复输尿管Y型异位开口。行利尿肾图检查:双肾总有效肾血浆流量为71.42 ml/min,双侧分肾功能相对摄取比,左肾为74.6%(上组肾16.22%,下组肾58.38%),右肾为25.2%(上组肾9.52%,下组肾15.88%)。膀胱镜检查:小阴唇内可见尿道口、阴道口、右侧输尿管异位开口,可见尿液持续自异位开口溢出;尿道内口近膀胱颈处可见左侧输尿管异位开口。在全麻下行腹腔镜右侧重复肾输尿管端侧吻合联合输尿管膀胱再植术,半年后行腹腔镜左侧重复输尿管端侧吻合联合输尿管膀胱再植术;分别于术后1个月返院复查,并拔除双J管。结果手术顺利完成,通过腹腔镜重建性手术恢复了该患儿双侧上尿路连续性及通畅性。术后随访1年,患儿双侧重复肾及输尿管积水得以明显改善,术后患儿无明显尿失禁及尿路感染症状。结论腹腔镜重复输尿管端侧吻合联合输尿管膀胱再植术治疗小儿不完全型重复肾远端输尿管Y型异位开口合并尿失禁,可挽救患侧重复肾上下组分肾功能,彻底解决输尿管异位开口导致的尿失禁,是一种安全有效的微创治疗方法。Objective To explore the experiences of laparoscopic reconstructive operation in the treatment of distal ureteral Y-shaped ectopic orifice with urinary incontinence in children with incomplete duplex kidney.Methods A retrospective analysis was made on the clinical data of a baby girl with bilateral distal ureteral Y-shaped ectopic orifice with urinary incontinence with incomplete duplex kidney.She was admitted to hospital for"leakage of urine and repeated urinary sensation for 6 months"in this study.CT examination:Bilateral duplex kidney and ureteral malformation,bilateral duplex hydronephrosis and ureter tortuous dilation,right lower group hydronephrosis and dilated ureters obvious,and bilateral duplex ureters may have ectopic opening.Retrograde urethrography through ectopic opening of ureter in vulva:Right duplex hydronephrosis and hydroureter,a same ectopic opening of right repeated ureters in vulva.Diuretic nephrography:Total effective renal plasma flow of both kidneys=71.42 ml/min,relative uptake ratio of bilateral renal function:L=74.6%(upper group kidney 16.22%,lower group kidney 58.38%),R=25.2%(upper group kidney 9.52%,lower group kidney 15.88%).Cystoscopy:Urethral orifice,vaginal orifice and right Y-shaped ectopic ureter opening can be seen in labia minora,and continuous overflow of urine from the ectopic opening can be seen,the same left ureter opening can be seen near the bladder neck on the left side of internal orifice of urethra.She was treated under general anesthesia with laparoscopic right end-to-side ureterostomy combined with ureterovesical replantation.One month after the operation,she returned to the hospital for reexamination and removed the D-J tube.Six months later,laparoscopic left ureteral end-to-side anastomosis combined with ureter bladder replantation was performed.Results The operation was successfully completed.The continuity and patency of bilateral upper urinary tract were restored by laparoscopic reconstruction.Follow up of over 1 year,her bilateral duplex hydronephrosis and hydr

关 键 词：重复肾 输尿管畸形 肾盂积水 尿失禁 腹腔镜 

分 类 号：R726.9[医药卫生—儿科]