摘要
目的探讨小儿巨大肾积水保留肾脏手术的疗效。方法回顾性分析我院1995年3月至2006年8月收治的16例小儿巨大肾积水临床资料。男6例,女10例。平均年龄3岁(4个月～12年)。术前均行KUB,IVU,超声或CT确诊。肾盂输尿管连接部梗阻14例,下腔静脉后输尿管1例,输尿管异位开口1例。术中排出积水后测量肾皮质厚度和肾盂尿PH值,同时手术治疗原发病,患肾实质行内翻折叠成形术。结果16例均手术成功,术中测患肾尿液PH<6.1的1例1侧,PH在6.1～7.1的15例16侧。术后6～8d拔除输尿管支架管,术后2周拔除肾造瘘管。16例患儿均获得随访,随访时间中位数6年(6个月～11年)。所有患儿患肾功能有不同程度改善。无1例患儿因患肾功能丧失需再次行肾切除术。结论小儿巨大肾积水不能作为肾切除的指征,应结合肾皮质厚度和肾盂尿PH值等选择外科手术治疗方法,尽可能保留肾脏。手术治疗原发病并行肾实质折叠缝合是治疗小儿巨大肾积水的有效方法之一。
objective To investigate the therapeutic effect of nephron-sparing surgery for pediatric with giant hydronephrosis. Methods We collected the data of 16 children with giant hydronephrosis （6 boys, 10 girls） from March 1995 to August 2006. The mean age was 3 years old （range from 4 months to 12 years old）. KUB, IVU, B-ultrasound and CT were performed on 16 children with giant hydronephrosis before operation. After water drainage from giant hydronephrosis, nephron-sparing surgery was performed in according to the renal appearance, color and luster, the thickness of renal cortex and the PH of the urin from pelvis. 14 patients was secondary to ureteropelvic junction obstruction, 1 patient retrocaval ureter and 1 patient ectopic opening of ureter. The primary diseases were dealed with at the same time of plication operation of renal cortex. Results Operation were accomplished in all 16 cases. To some extent, giant hydronephrosis were ameliorated with 6 years follow-up by IVU and B-ultrasound. Conclusions Pediatric giant hydronephrosis is not the indication for nephrectomy. Nephron-sparing surgery should be considered firstly in combination with the thickness of renal cortex, the PH of the urin from pelvis and the opposite kidney function. The therapeutic effect of this surgery is satisfied.
出处
《中华腔镜泌尿外科杂志（电子版）》
2009年第3期41-43,共3页
Chinese Journal of Endourology(Electronic Edition)
关键词
肾积水
小儿
梗阻
Hydronephrosis
Pediatrics
Operation
