摘要
目的探讨小儿肾盂输尿管成形术后再狭窄的原因及防治。方法对50例先天性肾盂输尿管连接部狭窄(UPJO)所致肾积水的治疗进行分析。记录肾积水程度、UPJO段长度、肾造瘘管及支架管情况、肾周引流管(膜)放置时间及引流量、有无再狭窄,病理检查UPJO段及再狭窄段。结果中度积水肾16例,重度积水肾35例。手术中见狭窄段长度<1 cm 6例,>2 cm 9例,余为1.5 cm左右。手术后输尿管支架管拔除时间为7-15 d(平均11.7 d)。放置肾周胶管引流30例、橡皮膜引流7例,引流量7-300 mL(平均30.5 mL)。病理组织检查可见UPJO段黏膜层变薄或脱失,黏膜下层呈慢性炎表现,45例标本可见黏膜下层纤维组织成分增多,2例还可见黏膜下和肌层内腺样增生改变。手术后再狭窄3例(Anderson-Hynes手术后2例,Y-V成形术后1例),二次手术后治愈。结论肾积水程度、UPJO段长度、尿引流情况对手术后肾盂输尿管连接部愈合均有影响。术中完整切除狭窄段、术后充分引流尿液、防止尿外渗是避免再狭窄的关键。
Objective To investigate the causes and prevention of restenosis after pyeloureteruplasty in children with ureteropelvic junction obstruction（UPJO）. Methods Clinical data of 50 cases of eungenital hydronephrosis caused by UPJO in children were retrospectively analyzed. The degree of hydronephrosis and length of UPJO during operation were investigated and the information for drainage, stents, restenosis, and pathology postoperation was studied. Results The severity of hydronephrosis was moderate in 16 cases and giant in 35 cases. The lengths of UPJO were less than 1 cm in 6 cases, more then 2 cm in 9 eases, and others about 1.5 cm. Stents were pulled out on an average of 11.7 days（ ranging from 7 to 15 days） postoperatively. Drainage tubes and drainage membrana around the kidneys were set in 30 and 7 cases, respectively. Volume of drainage was 30.5 mL（ rangiog from 7 to 300 ml.）. Histologically, mucous layer in stricture section became thin or missing,,and submucosa often manifested chronic inflammation, and fibrous tissue within submucosa increaed in 45 samples. Adenoid was found within submucosa and muscles. Three postoperative restenosis occured. Conclusions The serious hydronephrosis, longer UPJO and urinoma affect the healing of UPJO after pycloureteroplasty. Complete excision of stricture section in ope ration and good drainage of urine after operation are important to prevent restenosis.
出处
《实用儿科临床杂志》
CAS
CSCD
北大核心
2006年第23期1613-1614,1618,共3页
Journal of Applied Clinical Pediatrics
基金
黑龙江省科学技术计划项目资助(G00C191904)
