肾盂输尿管连接部与肾血管关系及其临床意义

The relationship between ureteropelvic junction and the vessels of kidney and its clinical significance

目的:为腔内肾盂切开术治疗肾盂输尿管连接部(UPJ)狭窄时切口部位和方向提供解剖学依据,并探讨狭窄的解剖学原因。方法:观测34具成人防腐尸体(死因均非泌尿系统疾病)的68侧UPJ跨越血管的类型、走行方向、位置及与UPJ的毗邻关系。结果:肾盂输尿管连接处至肾下极水平面的距离:左侧均数为(2.85±1.53)cm(-1.0￣4.5cm),右侧均数为(2.85±1.45)cm(-1.5￣5.5cm),(P>0.05)。UPJ前方有血管跨越者,占57.3%(39侧);UPJ后方有血管跨越者,占22%(15侧)。结论:(1)UPJ跨越血管的存在并不完全是UPJ梗阻的必然因素。(2)行腔内肾盂切开术时应根据UPJ是高位型还是低位型,高位型应选择沿侧壁切开,低位型若UPJ后方无血管时应沿后壁或后侧壁切开,若UPJ后方有血管时应沿侧壁切开。

Objective： To provide anatomic data for the choice of incisional position and direction when dealing with the narrow of pyeloureteral junction（UPI） adopting endopyelotomy and explore the reasons of the narrow formation. Methods： The vascular anatomic relationships of UPJ were studied in 68 kidneys obtained from 34 adult cadavers of both sexes who had no diseases of urinary system. The distance from the UPJ to the plane of the lower pole of kidney was measured too. Results： The distance from the UPJ to the plane of the lower pole were： left 2.85±1.53 cm （-1.0～4.5） cm, right 2.85±1.45 cm （-1.5～5.5） cm respectively （P〉0.05）. In 39 cases （57.3%）, there were vessels passed through the ventral surface of the UPJ, however 22% of the specimens there were vessels processed the dorsal surface of the UPJ. Conclusions： （1） The presence of the vessels at the anterior or posterior surface of the UPJ does not means inevitable obstruction; （2） The incised position of the UPJ stenosis should adopt lateral, dorsal or dorsal-lateral approaches according to the superior of inferior types of UPJ.