小儿先天性肾积水诊断及治疗

Diagnosis and Treatment of Congenital Hydronephrosis in Children

目的探讨小儿输尿管(UPJO)连接梗阻诊断及治疗经验。方法20例UPJO患儿分别行B超、IVU、CT等检查明确诊断,详细了解积水情况,皮质厚度,判断肾功能。采用Anderson-Hynes成形术,并应用双J管内支架引流连肾、肾盂造瘘治疗小儿UPJO。结果术前诊断符合率90%,14例采用由支架连肾造瘘术后有出血、感染、阻管8例,6例采用双J管连肾盂造瘘管无感染、出血、阻管现象。结论小儿UPJO以B超、IVU及CT相结合既能确诊又能判断肾皮质厚度、肾功能,Anderson-Hynes成形术为首选,术中采用双J管连肾盂造瘘管并发症少,使用安全,疗效可靠。

Objective To summarize the experience of diagnosis and treatment in children with ureteropelvic junction obstruction （UPJO）. Methods The diagnosis of 20 cases with UPJO were confirmed by type-B ultrasound, IVU and CT examinatlons,which provided valuable indexes to assess the degree of hydronephrosis, thickness of renal cortex and renal function. All the cases were operated with Anderson-Hynes pyeloplasty, internal stent （in 14 cases） or double-J stent （in 6 cases） and a nephrostomy tube were used to sustain and drainage during the operation. Results The coincidence rate of preoperative diagnosis was 90%. Of 14 cases with internal stent, 8 cases had complications of bleeding, infection and/or tube obstruction; but there were not complications in the 6 cases with double-J stent. Conclusions Children with UPJO can be diagnosed and the thickness of renal cortex and renal function can also be evaluated hy type-B ultrasound, IVU and CT. Anderson-Hynes pyeloplasty should be the first choice for the treatment of UPJO, a double-J stent and a nephrostomy tube should be indwelled in the pelvis and ureter during the operation, which is safe and dependable and will significantly reduce the complications.