原发性梗阻性巨输尿管

Primary obstructed megaureter

１９８２～１９９１年间收治原发性梗阻性巨输尿管２３例。儿童１７例，成人６例。按１９７６年美国费城小儿泌尿会议分类原则，本组病例包括输尿管末端闭锁、输尿管异位开口和无动力性输尿管。外科治疗２４侧巨输尿管，其中肾、输尿管切除５侧，输尿管再植１９侧。９侧输尿管末端切除后病检发现炎性反应，纤维及胶原组织增多，肌纤维减少，未见到副交感神经细胞。随访１８例输尿管再植患者，４例失访，１４例良好，其中１０例复查ＩＶＵ和ＶＣＵＧ，９例输尿管显著缩小，肾功能改善，１例无变化，无膀胱输尿管返流。结合文献复习，对分类、病理，诊断和治疗进行了讨论。

Twenty-three cases of primary obstructive megaureters has been admitled during l982～1991, with 6 in adult and 17 in children. This series consisted of atresia of ureteral end segment,ectopic ureter and adynamic ureter. 24 ureters were treated surgically, total renoureterectomy on the involved side being carried out for 5.Ureteral reimplantation with Politano-Leadbetter's technique was adopted for 19 ureters. The obstructive segment was resected in 9 cases, and histopathological examination of the distal ureter showed inflammation and increase collagen tissue with reduction of musculature. Parasympatholytic cell has never been observed.Of the 18 patients with reimplantation, 14 have had a good condition while the other 4 were missed. IVU and UCUG in 10 patients after operation showed that renal fanction has been improved with a marked reduction of ureteral diameter in 9 and vesicoureteric reflux has not been observed.The classification, pathology, clinical symptoms, morphologic features, diagonosis and surgical treatment were discustsed.