摘要
目的:评价采用输尿管端侧吻合术耦合输尿管膀胱再植术治疗儿童完全性重复肾畸形的疗效。方法:回顾性分析2010年1月至2018年12月采用输尿管端侧吻合术耦合输尿管膀胱再植术治疗的37例同侧双输尿管病变的完全性重复肾畸形患儿的临床资料。其中,男4例,女33例;患侧为左侧25例,右侧12例。临床症状中,尿路感染34例,滴尿2例,排尿困难1例。病理类型中(同一患儿不限于一种病理类型),上肾部输尿管异位开口11例,上肾部输尿管异位开口伴反流3例,上肾部输尿管囊肿26例,上肾部输尿管囊肿伴反流6例,下肾部输尿管反流26例,下肾部输尿管异位开口伴狭窄11例。分析手术时间、肾盂分离前后径(anterior and posterior diameter,APD)、输尿管直径、患肾分肾功能(differential renal function,DRF)、并发症等,评价这种术式的优缺点。结果:所有患儿均顺利完成同侧输尿管端侧吻合术耦合输尿管膀胱再植术,平均手术年龄为8.3个月,范围为4~110个月,手术时间为(128.84±35.06)min。术后上肾部APD为(9.41±6.40)mm,术后上肾部输尿管直径为(2.76±4.93)mm,术后下肾部APD为(5.49±6.47)mm,与术前同类数据相比,差异具有统计学意义(P<0.05)。术后下肾部输尿管直径为(2.05±4.10)mm,与术前下肾部输尿管直径相比差异无统计学意义(P>0.05)。术后DRF为(43.06±5.75)%,与术前DRF相比差异具有统计学意义(P<0.05)。术后平均随访时间为45.1个月,范围为13~120个月,患儿术后临床症状均消失,术后8.1%(3/37)出现并发症:1例术后半年复查积水下降不明显,DRF下降,输尿管膀胱吻合口处狭窄再次行手术治疗;2例术后2年出现间歇性排尿困难伴尿路感染,行膀胱镜下输尿管囊肿开窗术。结论:输尿管端侧吻合术耦合输尿管膀胱再植术是适用于儿童完全性肾重复畸形的安全、有效且并发症少的治疗方式。
Objective To evaluate the efficacy of surgery for ureteroureterostomy coupled with ureteral reimplantation of complete duplex kidney in children.Methods Retrospective analysis was conducted for clinical data of 37 children undergoing ureteroureterostomy coupled with ureteral reimplantation for upper/lower pole moiety ipsilateral ureteral lesion in complete duplex kidney from January 2010 to December 2018.There were 4 boys and 33 girls.The involved side was left(n=25)and right(n=12).Clinical symptoms included urinary tract infection(n=34),urinary dripping(n=2)and dysuria(n=1).Pathological types were ectopic opening of upper pole moiety ureter(n=11),ectopic opening of upper pole moiety ureter with reflux(n=3),upper pole moiety ureteral cyst(n=26),upper pole moiety ureteral cyst with reflux(n=6),lower pole moiety ureter with reflux(n=26)and ectopic opening of lower pole moiety ureter with stenosis(n=11).Operative duration,anterior and posterior diameter(APD)of pelvis,degree of ureteral dilatation,differential renal function(DRF)and postoperative complications were collected and statistically analyzed for evaluating the advantages and disadvantages of this operation.Results All operations were successfully completed.The median operative age was 8.3(4-110)months and the median operative duration(128.84±35.06)min.APD of upper moiety kidney(P=0.01),diameter of upper ureteral pole(P<0.05),APD of lower moiety kidney(P=0.02),diameter of lower ureteral pole(P=0.13)and DRF(P=0.02)improved postoperatively and all clinical symptoms disappeared.During a median follow-up period of 45.1(13-120)months,complications occurred(n=3,8.1%):One case with ureterovesical anastomotic stricture was re-operated and 2 cases of dysuria underwent transurethral incision of ureterocele subsequently.Conclusions Ureteroureterostomy coupled with ureteral reimplantation is both safe and effective for pediatric duplex kidney with few complications.
作者
方晓亮
王锦斌
耿红全
徐国锋
贺雷
李约延
张君颀
张琪敏
徐卯升
Fang Xiaoliang;Wang Jinbin;Geng Hongquan;Xu Guofeng;He Lei;Li Yueyan;Zhang Junqi;Zhang Qimin;Xu Maosheng(Department of Pediatric Urology,Affiliated Xinhua Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200092,China)
出处
《中华小儿外科杂志》
CSCD
北大核心
2020年第7期602-606,共5页
Chinese Journal of Pediatric Surgery
关键词
重复肾
肾畸形
输尿管再植术
儿童
Duplex kidney
Deformity of kidney
Ureteral reimplantation
Child
