肾盂成形术后梗阻的治疗(附31例分析)

Manage ment of failed pyeloplasty

目的 回顾性分析肾盂成形术后失败再治疗的经验，包括手术失败的原因，处理方法及结果。 方法 １９７２ ～１９９８ 年共收治肾盂成形术失败导致肾盂输尿管连接部持续梗阻的患儿３１例，其中２５ 例再次行离断性肾盂成形术，２ 例保守治疗，另有４ 例在再次手术时行肾切除术。 结果 ２６ 例成功地解除梗阻；１ 例患儿行两次离断性肾盂成形术，目前仍带肾造瘘管。再次治疗的总成功率为８４ ％ 。 结论 离断性肾盂成形术的手术成功率很高，如术后梗阻仍未解除，可根据情况再次行离断性肾盂成形术。对于梗阻不严重的病例，可试行放置双 Ｊ管治疗。

Objective To presentthe experience with repeated management offailed pyeloplasty . Methods Between 1972 and 1998 ,31 children who presented with recurrent ureteropelvic junction ob struction after failed pyeloplasty required managem ent . Repeated disme mbered pyeloplasty was required in25 children and conservative treatm ent in 2 . Four patients underwent nephrectom y at the initial repeatedprocedure . Results Obstruction was relieved successfully in 26 children . One patient had persistent ob struction after secondary failed disme mbered pyeloplasty . An overall success rate of repeated managementwas84 % (26/31) . Conclusions Dismem bered pyeloplasty has a very high success rate for primaryureteropelvic junction obstruction . If primary pyeloplasty fails , satisfactory resolution of obstruction isachieved by repeated dismem bered pyeloplasty . If obstruction is not severe ,a double Jstent placing mightbe successful.