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目的探讨小儿单侧肾发育不良的临床特点及诊断方法,评价腹腔镜治疗小儿单侧肾发育不良的价值和疗效。方法 2004年12月-2009年3月因单侧肾发育不良在本院经腹腔镜行肾及部分输尿管切除术的患儿9例。男3例,女6例;平均年龄5.2岁(2.5~10.0岁)。4例并输尿管开口异位,1例并泌尿系统感染。术前常规行多普勒超声、静脉肾盂造影(IVP)、IVP后延迟CT扫描三维重建和99Tcm-二乙烯三胺五乙酸(DTPA)核素扫描检查。结果超声探及肾发育不良6例。其中探及盆腔扩张输尿管1例;IVP检查均未显示肾发育不良;IVP后延迟CT扫描三维重建显示所有肾发育不良;99Tcm-DTPA核素扫描4例可见肾脏显影,5例在盆腔显示输尿管影像。腹腔镜找到了所有肾发育不良,平均手术时间75 min(61~162 min),术后所有患儿恢复平稳,尿淋漓消失,泌尿系统感染治愈。术中、术后无并发症发生,术后平均4.2 d(3~5 d)出院。随访3个月~5 a,患儿均恢复良好,排尿正常。结论腹腔镜治疗肾发育不良安全有效,即使术前影像学检查不能定位肾脏,腹腔镜也能成功切除患肾和输尿管。
Objective To investigate the clinical features and diagnosis of unilateral renal dysplasia in children and evaluate the value and efficacy of laparoscopic treatment of unilateral renal dysplasia in children. Methods From December 2004 to March 2009, 9 children with unilateral renal dysplasia underwent laparoscopic nephrectomy and partial ureterotomy. 3 males and 6 females; mean age 5.2 years (2.5 to 10.0 years). 4 cases and ureter open ectopic, 1 cases and urinary tract infections. Preoperative routine Doppler ultrasound, intravenous pyelography (IVP), post IVP delayed three-dimensional reconstruction of CT and 99Tcm-diethylenetriaminepentaacetic acid (DTPA) radionuclide scan examination. Results Ultrasound and renal dysplasia in 6 cases. One case of exploration and pelvic dilatation of the ureter; IVP examination showed no renal dysplasia; IVP delayed three-dimensional reconstruction of CT showed all renal dysplasia; 99Tcm-DTPA radionuclide scans showed renal imaging in 4 cases, 5 cases showed pelvic ureter imaging . Laparoscopy found all renal dysplasia, the average operation time 75 min (61 ~ 162 min), postoperative recovery of all children was stable, urine dripping disappear, urinary tract infection was cured. No intraoperative and postoperative complications occurred, and the average postoperative discharge was 4.2 days (3-5 days). All cases were followed up for 3 months to 5 years. All children recovered well and their voiding was normal. Conclusion Laparoscopic treatment of dysplasia of kidney is safe and effective, even if preoperative imaging can not locate the kidney, laparoscopic resection of kidney and ureter can be successfully removed.