摘要
目的探讨儿童重复肾畸形的不同腹腔镜微创处理方法。方法2018年1月至2019年6月,郑州大学第一附属医院小儿外科共收治儿童各类重复肾畸形患儿30例,其中反复泌尿道感染13例,排尿疼痛5例,肾区疼痛5例,非排尿期持续滴尿5例,无症状7例。经术前进行泌尿系彩色多普勒超声、磁共振泌尿系水成像、泌尿系CTU、肾动态显像、排尿性膀胱尿道造影等检查,诊断上位肾积水并输尿管扩张18例,上位肾发育不良伴上位输尿管全程扩张开口异位4例,上下位肾积水伴上下位输尿管均全程扩张3例,下位肾盂输尿管交界处梗阻5例,30例患儿中有输尿管囊肿8例。所有患儿均行腹腔镜微创手术,根据不同情况选用腹腔镜上位肾脏及输尿管切除术、腹腔镜上下位输尿管端侧吻合术、腹腔镜下位肾盂输尿管端侧吻合术、腹腔镜下位肾切除联合上位输尿管膀胱再植术、气膀胱下双根输尿管再植术、膀胱镜下输尿管囊肿基底部电切术等。结果本组所有手术均未中转开放,历时20~280 min,术中出血0~20 ml,均未输血。所有患儿随访6~12个月,11例上位肾切除术后下位肾血供好,滴尿症状完全消失,泌尿道感染无复发;5例上下位肾盂输尿管和输尿管之间端侧吻合术后肾积水缓解好;5例下位肾盂成形术患儿腹疼消失,积水缓解;2例双根输尿管移植术后拔除输尿管内支架情况稳定,排尿疼痛消失;6例膀胱镜下输尿管囊肿切开后,其中4例肾积水缓解无感染,2例出现泌尿道感染,经抗感染治疗后1例痊愈,另1例行腹腔镜上下位输尿管端侧吻合术并上位远端输尿管切除术,恢复顺利;另1例下位肾切除术并上位输尿管复位膀胱再植术后上位肾积水恢复好。结论微创手术处理各种重复肾畸形切实可靠,可根据患儿具体情况采取相应的处理方法;肾功能较好时应疏通流出道、解除梗阻,重复肾畸形出现上位肾或下位肾功能�
Objective To explore the experiences of managing pediatric duplex renal malformation with different endoscopic mini-invasive surgical procedures.Methods A total of 30 children with various types of duplex renal malformation were operated from January 2018 to June 2019.There were recurrent urinary tract infection(n=13),painful urination(n=5),pain in renal area(n=5),continuous urinary dripping during non-urination period(n=5)and asymptomatic(n=7).The preoperative examinations included color Doppler ultrasound of urinary system,magnetic resonance urography,computerized tomography of urography,renal dynamic imaging and voiding cystourethrogram,etc.Examination results revealed upper hydronephrosis&upper ureteral expansion(n=18),upper renal dysplasia with upper ureter expansion and ectopic opening(n=4),upper&lower hydronephrosis and upper&lower ureter expansion(n=3),lower ureteropelvic junction obstruction(n=5)and ureterocele(n=8).The choices of different endoscopic procedures depended upon patient characteristics.The specific procedures included laparoscopic upper kidney and ureter resection,laparoscopic ureteroureterostomy,laparoscopic pyeloureterostomy,laparoscopic lower nephrectomy plus upper ureteral bladder reimplantation,laparoscopic double ureteral reimplantation under air bladder and cystoscopic electrotomy of lower ureteroceles,etc.Results None of operations was converted into open procedure.The operative duration was 20 to 280 min and the volume of intraoperative hemorrhage 0-20 ml.There was no blood transfusion.The follow-up period was 6-12 months.Blood supply of lower kidneys was excellent in 11 cases after upper nephrectomy.The symptoms of continuous urinary dripping during non-urination period disappeared completely without a recurrence of urinary tract infection.Hydronephrosis was relieved after ureteroureterostomy and pyeloureterostomy(n=5).Renal area pain disappeared after pyeloplasty and hydronephrosis was relieved(n=5).Painful urination disappeared after double ureteral reimplantation and a removal
作者
李骥
张谦
郭立华
王磊
刘艳飞
刘宁
王冰蕊
Li Ji;Zhang Qian;Guo Lihua;Wang Lei;Liu Yanfei;Liu Ning;Wang Bingrui(Department of Pediatric Surgery,First Affiliated Hospital,Zhengzhou University,Zhengzhou 450052,China)
出处
《中华小儿外科杂志》
CSCD
北大核心
2020年第5期431-436,共6页
Chinese Journal of Pediatric Surgery
关键词
肾
畸形
肾盂积水
输尿管扩张
输尿管疝
外科手术
腹腔镜
Kidney
malformation
Hydronephrosis
Ureteral expansion
Ureterocele
Surgical procedures
laparoscopes
