摘要
目的 选用创伤小、疗效好的术式治疗输尿管膨出症 ,减少二次手术。方法 91例输尿管膨出症 ,男 2 5例 ,女 6 6例。其中 70例 (76 .9% )并发于重肾双输尿管畸形 ,其中左上输尿管膨出症 4 0例、右上 2 7例、双上 3例。影像学检查 :双上肾积水 4例 ,患侧上肾积水 5 2例 ,患侧上下肾积水10例 ,患侧上、下及对侧都有肾积水 4例。 2 1例单一系统输尿管膨出症中 ,左侧 5例 ,右侧 11例 ,双侧 5例。影像学检查 :患侧肾积水 10例、双侧肾积水 5例 ,患肾功能严重受损 5例 ,上尿路正常 1例。结果 78例 (85 .7% )术后平均随访 2年。重肾组 :①上肾部切除 4 8例 5 2侧 ,治愈 36例 ,失访 7例 ,需加做输尿管残段切除 3例 ,需再经尿道戳穿输尿管膨出 2例 ;②切除输尿管膨出及输尿管膀胱再吻合 6例 ,治愈 5例 ,术后加做上肾部切除 1例 ;③经尿道戳穿输尿管膨出 15例 ,治愈 9例 ,失访 4例 ,需加做上肾部切除 2例 ;④输尿管膨出自行缩小 ,症状消失 1例。单一系统 2 1例中 15例经尿道戳穿输尿管膨出 ,治愈 12例 ,失访 2例 ,需加做输尿管膀胱再植 1例。 1例经输尿管膨出切除 ,输尿管膀胱再植治愈。发育不良肾切除 5例 ,治愈 2例 ,有尿失禁症状 2例 ,仍时有尿路感染 1例。全组 1次手术治愈 6 5例。
Objective To identify factors related to recurrence of ureterocele. Methods Ninety one patients (male 25, female 66) with ureterocele were studied. Seventy patients had duplex kidneys associated ureteroceles. These included 40 left upper, 27 right upper, and 3 bilateral upper ureteroceles. Imaging studies showed hydronephrosis and hydroureter of bilateral upper renal moieties in 4 patients, ipsilateral upper renal moieties in 52, ipsilateral upper and lower renal moieties in 10, bilateral hydronephrosis and hydroureter in 4. Twenty one patients had ureteroceles without duplex kidney, including 5 on the left side, 11 on the right, and 5 bilaterally. Imaging examination showed bilateral hydronephrosis and hydroureter in 5 patients, unilateral in 10, nonfunctioning of the diseased kidney in 5, and normal upper urinary tract in 1. Results Seventy eight patients were followed up for a mean of 2 years. Of 59 patients with duplex system, 5/41(12%), 1/6(17%) and 2/11(18%) respectively required a second operation after the excision of the upper renal moiety, ureterocele excision with ureteral reimplantation, and endoscopic puncture of ureterocele. The secondary operation included resection of the ureteral stump remnant in 3 patients, endoscopic puncture of the ureterocele in 2, and resection of the upper renal moiety in 3. One child had spontaneous resolution of uretrocele and has been free of symptoms. 19 patients with single system required further operations. The secondary management included reimplantation of ureter in one, 2 patients had urinary incontinence and one with urinary infection still waiting for further investigation. Conclusions In patients with ureterocele and nonfunctioning kidney, partial or total nephrectomy should be considered as the treatment of choice. Otherwise endoscopic ureterocele decompression has identical cure rates. Of single system ectopic ureterocele with hypoplastic kidney further management may be needed to achieve urinary continence.
出处
《中华小儿外科杂志》
CSCD
北大核心
2002年第6期496-498,共3页
Chinese Journal of Pediatric Surgery
