重复肾上肾切除术后上肾输尿管末端膨出的转归分析  

Outcomes of ureterocele after partial nephrectomy for duplex kidneys

作　　者：杜国强 朱光宇[2] 郭锋 武翔宇 徐宏业 吴荣德 刘伟 Du Guoqiang;Zhu Guangyu;Guo Feng;Wu Xiangyu;Xu Hongye;Wu Rongde;Liu Wei(Department of Pediatric Surgery,Affiliated Shandong Provincial Hospital,Shandong First Medical University,Jinan 250021,China;Department of Pediatric Surgery,Affiliated Children's Hospital,Xi'an Jiao Tong University,Xi'an 710003,China)

机构地区：[1]山东第一医科大学附属省立医院小儿外科,济南250021 [2]西安交通大学附属儿童医院小儿外科,西安710003

出　　处：《中华小儿外科杂志》2023年第10期931-935,共5页Chinese Journal of Pediatric Surgery

摘　　要：目的分析上肾功能差的重复肾合并输尿管膨出患儿,行上肾输尿管切除术后,输尿管膨出的转归情况。方法回顾性分析1998年9月至2019年6月山东第一医科大学附属省立医院收治的重复肾合并上肾输尿管末端膨出的32例患儿临床资料。所有患儿经后腹腔镜入路,行重复肾上肾输尿管切除术,随访其术后输尿管膨出的变化、并发症及再手术情况,分析输尿管膨出的转归情况。结果最终仅24例患儿获得随访,获访患儿的手术年龄为(23.3±18.9)个月,范围在3~81个月;随访时间为(85.4±34.8)个月。其中19例术后超声检查提示输尿管膨出消失,4例输尿管膨出较术前缩小,1例输尿管膨出较术前无明显变化。术后共发生并发症5例:1例输尿管膨出自尿道外口再次脱出行手术治疗;2例输尿管膨出感染,经抗生素治疗后好转;2例术后出现泌尿系感染,排尿期膀胱尿道造影显示下肾输尿管反流。1例反流为Ⅳ级,同时合并上肾输尿管残端的感染,行残存输尿管膨出切除及下肾输尿管膀胱再植术;另外1例反流为Ⅱ级,目前在观察中。结论对于上肾功能差的重复肾合并输尿管膨出患儿,行上肾输尿管切除术后,输尿管膨出多数会消失或缩小至无明显临床症状,仅少数会出现并发症,术后需要注意警惕感染及下肾输尿管反流。Objective To explore the outcomes of ureterocele after upper nephroureterectomy in children of renal dysfunction with duplex kidney complicated with ureterocele.Methods From September 1998 to June 2019,the relevant clinical data were retrospectively reviewed for 32 children hospitalized with duplex kidney complicated with upper renal ureterocele at Affiliated Provincial Hospital.Suprenal nephroureterectomy was performed by retroperitoneal laparoscopy.The changes of postoperative ureterocele,complications and reoperation were followed up.Results Finally a total of 24 children were followed up for a period of(85.4±34.8)month.Operative age was(23.3±18.9)(3-81)months.Postoperative ultrasonography of ureterocele revealed resolution(n=19),shrinkage(n=4)and no obvious change(n=1).Postoperative complications included protrusion of ureterocele from external urethral orifice(n=1),ureterocele infection(n=2)and urinary tract infection(n=2).Infection was improved after antibiotic dosing.Cystourethrography hinted at lower renoureteral reflux during micturition.One child of gradeⅣreflux complicated with infection of upper renoureteral stump underwent resection of residual ureterocele and replantation of ureter/bladder of lower kidney.Another child of gradeⅡreflux remained under observation.Conclusions For children of renal dysfunction with duplex kidney complicated with ureterocele after upper nephroureterectomy,ureterocele may disappear or shrink to no obvious clinical symptoms.Only few have complications.Clinicians should pay great attention to infection and lower renal ureteral reflux.

关 键 词：先天畸形 重复肾 输尿管口囊肿 肾输尿管切除术 

分 类 号：R726.9[医药卫生—儿科]