儿童输尿管膨出并上尿路畸形66例诊治分析  

Clinical analysis of 66 cases of ureterocele with upper urinary malformation in children

作　　者：周广伦[1] 孙俊杰 尹鉴淳[1] 杨志林[1] 李守林[1] ZHOU Guang-lun;SUN Jun-jie;YIN Jian-chun;YANG Zhi-lin;LI Shou-lin(Department of Urinary Surgery,Shenzhen Children's Hospital,Shenzhen 518034,Guangdong,CHINA)

机构地区：[1]深圳市儿童医院泌尿外科,广东深圳518034

出　　处：《海南医学》2021年第22期2954-2956,共3页Hainan Medical Journal

摘　　要：目的探讨儿童输尿管膨出并上尿路畸形的诊治策略。方法回顾性分析深圳市儿童医院泌尿外科2013—2019年收治的66例(女性44例,男性22例)输尿管膨出并上尿路畸形患儿的临床资料。结果患儿年龄平均2.3岁。临床表现以发热(38例)最常见,部分为尿路感染(23例)。术前66例均行超声及泌尿系水成像(MRU)检查。术前影像学诊断合并患侧重复肾43例,患侧肾积水11例,患侧肾发育不良9例,患侧巨输尿管3例。38例行腹腔镜重复上肾或患肾切除术,16例行输尿管膀胱再植术,10例行输尿管膨出切开术,1例行腹腔镜输尿管端侧吻合术,1例行腹腔镜右半肾切除、左输尿管膨出切开术。65例获随访(失访1例),随访时间平均27.6个月。6例出现尿路感染,2例因反复感染再手术,余4例经抗感染治愈。结论输尿管膨出并上尿路畸形以发热和尿路感染为主要表现。超声是检查输尿管膨出的首选方法,术前需多种检查充分评估分肾功能形态,对肾功能良好者建议行输尿管膀胱再植、输尿管膨出切开或输尿管端侧吻合术,肾输尿管切除术适用于分肾功能差者,该病术后预后较好。Objective To investigate the clinical treatment options of ureterocele with upper urinary malformation in children.Methods The clinical data of 66 patients of ureterocele with upper urinary malformation who were hospitalized at Shenzhen Children’s Hospital from 2013 to 2019 were retrospectively analyzed,including 44 females and22 males.Results The average age of the patients was 2.3 years old.Fever was the most common clinical manifestation(38 cases),followed by urinary tract infection(23 cases).All the 66 cases were examined by ultrasonography and MR urography(MRU)before operation.The results showed that 43 cases were complicated with renal duplication,11 cases with hydronephrosis,9 cases with renal dysplasia,and 3 cases with megaureter.Thirty-eight cases underwent laparoscopic nephrectomy,16 cases underwent ureteral replantation,10 cases underwent transurethral incision of ureteroceles,1 case underwent ureteroureterostomy(UU),and 1 case underwent nephrectomy and incision of ureteroceles.Sixty-five cases were followed up after discharge,and the average follow-up time was 27.6 months.Six cases developed urinary tract infection,of which 2 cases were re-operated due to repeated infection and 4 cases were cured by anti-infection therapy.Conclusion Fever and urinary tract infection are the most common manifestation of ureterocele with upper urinary malformation,and ultrasound of urinary system is recommended for the diagnosis of this disease.It is very important to evaluate the renal function before the operation.Patients with good renal function are better to be treated with transurethral incision of ureteroceles and ureteral replantation and UU,and those with poor renal function are recommend to receive laparoscopic nephrectomy.The prognosis of the disease is good.

关 键 词：输尿管膨出 肾脏畸形 治疗 儿童 诊断 

分 类 号：R726.9[医药卫生—儿科]