小婴儿重度先天性肾积水手术治疗

Surgical treatment of congenital giant hydronephrosis in infants

目的提高小婴儿重度肾积水的治疗效果。方法对8例年龄在3个月内的重度肾积水手术治疗结果进行分析。经B超、静脉尿路造影(IVU)、CT、MRI、ECT等检查,行离断性肾盂成形术(Anderson-Hynes术式)。结果8例手术经过顺利,术后恢复良好。随访5个月以上,无血尿、腹块、腹胀,尿常规正常,均获临床治愈。7例复查IVU手术侧肾功能明显改善,其中2例患侧输尿管显示良好。1例复查SPECT,患肾GFR较术前明显提高。结论小婴儿(包括新生儿)肾盂输尿管连接处梗阻所致重度肾积水应及时手术,以避免患肾肾功能进行性损害。小婴儿肾脏功能恢复能力较强,对肾盂积水一般均应考虑保留肾脏。离断性肾盂成形术技术已成熟,手术打击较小,小婴儿多可以耐受。虽然小婴儿组织脆弱、输尿管较细,但只要注意于术操作精细,对合准确,可避免并发症的发生。

Objective To investigate the effect of surgical treatment on severe congenital hy-dronephrosis with ureteropelvic junction obstruction(UPJO) in infants. Methods The diagnosis of 8 cases less than 3 months were confirmed by ultrasonogram, IVU,CT,MRI and ECT examinations between January, 2000 and June, 2003. All patients underwent Anderson-Hynes procedures. Results The operations were carried out successfully and the patients were followed-up for at least 5 months. After the operation, the abdominal mass, hematuria and abdominal distention disappeared and the urine analysis was normal. All cases cured clinically. Significantly improved renal function on IVU examinations was observed in 7 of 8 patients compared with that before the operations. The ureters of 2 cases displayed very well. Plus, improved GFR examined by SPECT was observed in one patient compared with that before the operations. Conclusions The surgical treatment should be applied to infants with giant hydronephrosis due to UPJO, otherwise, the renal function will be ultimately damaged. The kidneys should be reserved because the recovery functions of the kidney were very strong in infants. The Anderson-Hynes technique was safe and could be tolerated in small infants with minimal strike. To prevent complication, the operation should be carried out carefully with accurate anastomoses, because the neonatal renal and ureteral tissues are very tender and weak.