输尿管异位开口的诊断与治疗(附32例报告)

Diagnosis and surgical treatment of ectopic ureter with urinary tract malformations

目的探讨输尿管异位开口的诊断及治疗。方法回顾性分析32例异位输尿管开口患者的临床资料,采用B超检查28例,IVU29例,CT13例、MRU7例,膀胱镜检查13例,异位开口插管造影8例,膀胱尿道、阴道造影12例。对其临床特点、诊断及外科治疗方式进行分析。结果术前确诊28例(93.3%)。行单侧肾脏输尿管或上半肾输尿管切除各12例,输尿管膀胱再植术4例,分期行左、右输尿管膀胱再植、左掌长肌移植尿道括约肌成形1例,左上重复肾、输尿管切除及左下、右侧输尿管膀胱再植1例,未行手术2例。30例术后随访3-16年,效果良好。结论输尿管异位开口的诊断需结合病史、体检、B超、IVU、膀胱镜、CT、MRU等检查进行综合分析,必要时行腹腔镜检查。上半肾输尿管切除及输尿管膀胱再植是治疗输尿管异位开口合并上/下尿路畸形的有效方式。

Objective To summarize the experience of the diagnosis and treatment of ectopic ureter with urinary tract malformations. Methods 32 cases of ectopic ureter were analyzed retrospectively. Sonography, IVU, CT, MRU, cystoscopy,retrograde ureterography and cystourethrography （colpography） were applied respectively. Results 28 （93.3%） cases were diagnosed correctly preoperatively. 12 cases received ureteronephrectomy, 12 upper pole partial ureteronephrectomy, 4 ureterovesicle reimplantation, 1 reimplantation, and 1 case received bialateral ureterovesicle All cases were followed up for 3 to 16 years. Conclusion left upper pole partial ureteronephrectomy and urcterovesicle reimplantation and urethral sphincterplasty with palmaris longus. Most of the cases can be diagnosed preoperatively by appropriate methods. Upper pole partial ureteronephrectomy and ureterovesicle reimplantation are effective in the treatment of ectopic ureter with urinary tract malformations.