先天性巨输尿管症的诊治(附17例报告)

Diagnosis and treatment of congenital megaureter (report of 17 cases)

目的探讨先天性巨输尿管症的诊治方法。方法回顾性分析17例共20侧先天性巨输尿管症患者的临床资料,其中左侧9例,右侧5例,双侧3例。手术治疗14例17侧,其中输尿管裁剪输尿管膀胱吻合术10例13侧,肾输尿管切除2例2侧,输尿管折叠输尿管膀胱吻合术2例2侧,3例3侧行内镜扩张术。结果随访1-5年(平均3年),经内镜扩张3例,其中1例患者术后临床症状缓解,输尿管扩张有减轻,2例患者症状改善不明显,肾积水、输尿管扩张无明显减轻;14例手术患者中10例获随访,输尿管裁剪、输尿管膀胱吻合术患者中7例示手术侧输尿管扩张明显减轻,1例肾积水无明显减轻,但症状明显改善,2例肾输尿管切除者行B超检查,显示对侧肾脏代偿性增大;全部患者肾功能检查均正常;输尿管功能性梗阻段经病理检查提示环肌肥厚、纵肌减少9侧,其中3侧伴管壁全层炎症改变,管壁胶原组织增生7侧,纵肌增生1侧。结论MRU检查在先天性巨输尿管症的诊断中有重要意义;输尿管裁剪整形加抗逆流的输尿管膀胱吻合术是治疗先天性巨输尿管症的首选手术方式。

Objective To discuss the diagnoses and treatment of congenital megaureter. Methods The data of 17 cases with 20 megaureters were reviewed. 9 megaureters were on the left side, 5 on the right side, and 3 on both sides. 14 patients with 17 megaureters were treated by surgical operation, including 10 cases with 13 megaureters treated by ureteroplasty and ureterocystanastomosis, 2 by folding ureterorrhaphy and ureterocystonastomosis, and 2 by ureteronephrectomy. 3 cases were treated by endoscope enlargement. Results The 3 patients treated by endoscope enlargement were followed up, and only 1 had satisfying results. Among the 14 patients operated, 10 were followed up for 1 to 5 years, the average time being 3 years. 7 cases treated by ureteroplasty and ureterocystanastomosis showed observious easing of dilated ureter. Hydronephrosis didn＇t change too much in 1 case, but the symptoms had improved much. Histopathological studies of the functional obstructive segment revealed a great increase of collagen fibres in 7 samples, reduction of longitudinal musculature and hypertrophy of circular musculature in 9 samples, and hyperplasia of longitudinal musculature in 1 sample. Conclusion MRU is a very important method to diagnose congenital megaureter. The operation of ureteroplasty and ureterocystanastomosis is the first choice.