论文部分内容阅读
目的:探讨成人先天性巨输尿管症(CM)的诊治方法。方法:回顾性分析37例成人CM的临床资料:男18例,女19例。左侧18例,右侧10例,双侧9例。超声检查、静脉尿路造影(IVU)检查提示输尿管全段扩张伴肾盂积水22例,输尿管下段扩张9例。IVU不显影或显影不清13例;同位素肾动态显像检查提示患肾不同程度损害。手术治疗34例,其中行肾输尿管切除术2例,输尿管膀胱再植术32例。间断性双J管置入1例,保守观察2例。结果:随访32例,随访时间4个月～20年。患侧肾输尿管积水减轻29例,无明显变化3例。结论:成人CM的诊断主要依据影像学检查。治疗原则为解除梗阻、尽量保留患肾功能,应根据输尿管扩张程度选择输尿管折叠或裁剪加输尿管膀胱再植术,吻合方法推荐Lich-Gregoir术式;肾功能良好、无明显症状者可保守治疗。
Objective: To explore the diagnosis and treatment of adult congenital megacureou (CM). Methods: A retrospective analysis of 37 cases of adult CM clinical data: 18 males and 19 females. Left in 18 cases, right in 10 cases, bilateral in 9 cases. Ultrasound examination, intravenous urography (IVU) examination prompted the expansion of the entire ureter with hydronephrosis in 22 cases, lower ureteral expansion in 9 cases. IVU did not develop or develop unclear in 13 cases; isotope renal dynamic imaging examination showed different degrees of renal damage. Surgical treatment of 34 cases, including 2 cases of nephroureterectomy, ureteral bladder replantation in 32 cases. Intermittent double J tube into 1 case, conservative observation in 2 cases. Results: 32 cases were followed up for 4 months to 20 years. Ipsilateral renal hydronephrosis in 29 cases, no significant change in 3 cases. Conclusion: The diagnosis of adult CM is mainly based on imaging examination. Treatment principle to relieve obstruction, try to retain the risk of renal function, should be based on the degree of ureteral expansion ureter fold or cut plus ureteral bladder replantation, anastomosis recommended Lich-Gregoir surgery; renal function is good, no obvious symptoms may be conservative treatment.