顺行和逆行输尿管镜联合会师治疗肾盂输尿管连接部闭锁的中期随访结果

The intermediate follow-ups of combined antegrade and retrograde ureteroscope in the treatment of ureteropelvic junction atresia

目的:观察顺行和逆行输尿管镜联合会师治疗肾盂输尿管连接部(UPJ)闭锁的中期结果,评价治疗的中期效果。方法:16例UPJ闭锁患者,在复通出院后6周开始复查,以后定期3～6个月随诊,复查静脉尿路造影(IVU)、B超及肾功能,必要时行核素肾图及输尿管镜检查。结果:16例随诊时间16～61个月,平均48.6个月。8例IVU显示输尿管通畅,原有肾积水有改善,患肾功能有所恢复。5例复查显示UPJ段再狭窄,需进行二次输尿管镜内切扩张及置管术。2例放置记忆金属网状支架者分别于术后7个月及11个月出现闭锁段肉芽组织生长,需进行输尿管镜下切除和钬激光汽化。1例因感染及肾功能恶化于术后16个月行肾切除。结论:腔内泌尿外科技术治疗UPJ闭锁创伤小、安全、有效,对于复通后的再狭窄,亦可再次进行内镜下治疗。中期随访结果比较满意,支持该技术作为治疗UPJ闭锁的一线方法。

Objecitve To evaluate the intermediate follow-up of combined antegrade and retrograde ureteroscopic in the treatment of ureteropelvic junction （UPJ） atresia. Methods Sixteen patients were postoperatively rechecked at the end of 6 weeks and every 3-6 months. The most items were intravenous urogram（IVU）, B ultrasound and renal function, the nucleus nephrogram and ureteroscope were carried out if necessary. Results Sixteen patients were followed up 16 months to 61 months, the average time was 48.6 months. Eight patients demonstrated ureter unobstructed by IVU, the decreased hydronephrosis and the improved renal function. The UPJ appeared restenosis in 5 patients, so that the second time ureteroscopie dilation and stent inserting was needed. The polyps appeared in the area of atresia of the 2 patients with metal reticulation stent in 7 months and 11 months after operation and they need be ablated. One patient accepted nephrectomy because of infection and renal failure in 16 months postoperation. Conclusions It is little trauma, safe and effective with the endourologie technique in treatment of UPJ atresia. If appeared restenosis, it could be cured once more with the same method. The result of intermediate stage was satisfied and it supports the endourologic technique act as the first line method in treatment of UPJ atresia.