摘要
目的探讨儿童输尿管开口异位伴膀胱颈尿道发育不良的诊断和治疗特点。方法回顾性分析重庆医科大学附属儿童医院1993年9月至2019年4月收治的6例输尿管开口异位伴膀胱颈尿道发育不良患儿的临床资料。均为女性,年龄2~15岁,中位年龄7岁。左侧3例,右侧1例,双侧2例。5例表现为排尿间隙点滴性尿失禁,1例表现为持续尿失禁而无正常排尿。术前通过B超、静脉肾盂造影、膀胱镜、逆行泌尿系造影等检查,发现异位输尿管开口位于阴道壁2例,位于膀胱颈4例;重复肾畸形伴输尿管开口异位2例,肾发育不良伴输尿管开口异位4例;术前膀胱镜检查同时发现尿道宽而短1例,膀胱颈宽大合并尿道宽而短4例。手术方式:例1~3行发育不良肾及输尿管切除术,例4行双侧输尿管膀胱再植术,例5行双侧输尿管膀胱再植联合膀胱颈成形术,例6行发育不良肾切除联合膀胱颈成形及尿道成形术。结果术后1例失访;5例获得随访,平均随访41.2个月(2~84个月)。术中未处理膀胱颈尿道发育不良畸形的4例患儿均因尿失禁无缓解再行手术治疗:例1术后2周行尿道成形及延长术,尿失禁部分缓解;例2术后3年膀胱镜检查示膀胱颈宽大畸形,行膀胱颈成形术,第1次术后5年行膀胱镜检查示尿道阴道瘘,遂行瘘修补术,尿失禁完全缓解;例3术后2年因反复尿路感染行输尿管残端切除术,第1次术后3年行膀胱颈成形、尿道成形术,第1次术后6年再行膀胱颈成形、尿道成形术,尿失禁部分缓解;例4术后1年行膀胱颈成形、尿道成形术,尿失禁部分缓解。2例联合手术患儿中,例5术后失访,例6术后尿失禁完全缓解。结论合并膀胱颈尿道发育不良是手术治疗儿童输尿管开口异位预后不良的主要原因之一。膀胱颈尿道发育不良的诊断主要依靠膀胱镜检查。膀胱颈成形、尿道成形术对于膀胱颈尿道发育不良所致尿失禁有较好的疗效�
Objective To discuss the diagnosis and treatment of ectopic ureter company with the bladder neck and urethral maldevelopment in children.Methods The clinical data of the 6 patients admitted to Children’s Hospital affiliated to Chongqing Medical University from September 1993 to April 2019 diagnosed as ectopic ureter company with the bladder neck and urethral maldevelopment were retrospectively reviewed.The 6 children were girls and the median age was 7 years old,ranged from 2 to 15 years old.All children had ectopic ureter,including 3 in left-sided,1 in right-sided,and 2 in bilateral-sided.Five children presented the intermittent dribbling incontinence and one child presented the continuously incontinence without normal voiding.Through ultrasound,IVP,MRI,cystoscopy and retrograde urography,seven ureters were found ectopic position,including bladder neck in 4 cases,two ureters inserted in the vagina in 2 cases.There were two cases with duplex kidney and 4 cases with renal dysplasia.Preoperative cystoscopy revealed wide and short urethra in 1 case,wide bladder neck combined with wide and short urethra in 4 cases.The surgery type included nephrectomy in cases 1-3,bilateral ureter reimplantation in case 4 who had the bilateral ectopic ureter,bilateral ureter reimplantation and bladder neck reconstruction at the same time in case 5.Nephrectomy associated with bladder neck and urethral reconstruction in case 6.Results Five patients were followed-up and one patient was lost to follow-up after the first operation.Mean follow-up was 41.2 months(ranging 2 to 84 months).Four patients with bladder neck and maldevelopment that were not solved intraoperatively got reoperations due to incontinence without remission.Case 1,who underwent urethral reconstruction and extension,and urinary incontinence was partially relieved.Case 2 was found to have wide bladder neck deformity,and then retrospectively got bladder neck reconstruction and urethrovaginal fistula repair in 3 years and 5 years later.The urinary incontinence was complet
作者
吴双霜
何大维
肖兴望
唐悦
刘星
陆鹏
张德迎
刘丰
林涛
魏光辉
Wu Shuangshuang;He Dawei;Xiao Xingwang;Tang Yue;Liu Xing;Lu Peng;Zhang Deying;Liu Feng;Lin Tao;Wei Guanghui(Department of Urology,Children′s Hospital of Chongqing Medical University,National Clinical Research Center for Child Health and Disorders,Ministry of Education Key Laboratory of Child Development and Disorders,Chongqing Key Laboratory of Pediatrics,Chongqing 400014,China)
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2020年第11期851-855,共5页
Chinese Journal of Urology
