论文部分内容阅读
目的探讨双侧肾盂输尿管连接部梗阻(UPJO)致双肾重度积水的诊断治疗效果。方法回顾总结本院2008年1月-2009年7月诊治的双侧UPJO致双肾重度积水婴幼儿17例[14例Ⅰ期行双侧离断式肾盂成形术(Anderson-Hynes术),3例Ⅰ期行单侧离断式肾盂成形术+对侧肾造瘘术、Ⅱ期行对侧离断式肾盂成形术],手术年龄(45±11)d,并于术后3个月、6个月、1 a、2 a行彩超、核素肾显像、尿常规等检查及随访。结果 34侧肾脏术后1例单侧肾出现尿外渗,1例单侧肾出现吻合口狭窄,无出血、切口感染等并发症;末次随访(2a)17例患儿尿常规均正常,彩超提示积水均≤2级,相对肾功能(单侧肾小球滤过率/双侧肾小球滤过率)为(47.30±5.18)%,患儿均未出现肾盂、肾盏分离加大情况,肾皮质厚度逐渐增加,肾功能逐渐恢复。结论确诊存在器质性梗阻的双肾重度积水患儿应尽早手术干预,Ⅰ期双侧离断式肾盂成形术不但疗效确切,且避免了患儿二次手术的痛苦,可作为首选术式;同时应加强术后随访。
Objective To investigate the diagnosis and treatment of bilateral hydronephrosis caused by ureteropelvic junction obstruction (UPJO). Methods A retrospective review of 17 cases of bilateral juvenile hydrocephalus caused by bilateral UPJO treated in our hospital from January 2008 to July 2009 [14 cases of stage Ⅰ anderson-Hynes operation] 3 cases underwent unilateral pyeloplasty and contralateral nephrostomy in the first stage, and contralateral pyeloplasty in the second stage], and the operative age was 45 ± 11 days. Three months after the operation, , 6 months, 1 a, 2 a color ultrasound, radionuclide imaging, urine routine examination and follow-up. Results One side of renal in renal side after operation showed urine extravasation, one case of unilateral renal anastomotic stenosis, no bleeding, incision infection and other complications; the last follow-up (2a) 17 cases of children with normal urinalysis, (P <0.05), suggesting that all patients had ≤2 grade of water retention, relative renal function (unilateral glomerular filtration rate / bilateral glomerular filtration rate) was (47.30 ± 5.18)%, no renal pelvis, Circumstances, renal cortical thickness gradually increased, renal function gradually restored. Conclusions The patients with severe hydronephrosis diagnosed with organic obstruction should be treated as soon as possible. Stage Ⅰ double sided pyeloplasty not only has the exact curative effect but also avoids the pain of secondary operation in children, which can be used as the preferred surgical method ; At the same time should strengthen postoperative follow-up.