小儿肾重复畸形的病理解剖改变及其临床意义

Anatomical changes of duplicate kidney and its significance

目的 探讨肾重复畸形病理改变及与影像所见、手术之间关系。 方法 对 1 2 8例手术治疗病例术中进行观察 ,描述肾、输尿管的解剖改变 ,对比超声、IVU、SPECT检查结果。 结果 重肾多位于上肾段 ,占 96 .8% ,与下肾段为一体 ,共处在一个脂肪囊内 ,有各自的肾盏、肾盂等集合系统 ,重肾外观分为发育型、积水型和发育不良三型 ,支配重肾的血管分支少。两条输尿管下行在一个鞘内 ,其间有一条动、静脉 ,共同支配其血运。重复输尿管外观粗大、苍白、蠕动无力 ,绕下输尿管走行 ;49例输尿管末端合并囊肿 ,2 6例合并输尿管异位开口。 结论 肾重复畸形的病理解剖改变有规律性 ,明确其解剖变异对提高确诊率和选择治疗方案均有重要意义。

Objective To clarify the relationship between the anatomical changes and imaging.Ope rative findings in duplicate kidney. Methods The anatomical changes of the duplicate kidney and ureter were observed during operation in 128 cases.The anatomical changes were correlated with the ultrasonography, IVU and SPECT findings. Results Most of the duplicate kidney was located at the upper renal segment (96.8%) confusing with the lower segment both of which being in the same fatty capsule.The two had separated calyses and pelvis.From the gross appearance, duplicate kidney could be classified into developed type, the hydronephrosis type and the dysplasia type.The blood supplying of the duplicate kidney was less.The 2 ureters were in the same fascial compartment with an artery and a vein.The duplicate ureter looked thick and pale and its peristalsis feeble.The upper ureter was usually circumventing the lower one.49 cases were complicated by ureterocele and 26 by an ectopic ureteral orifice. Conclusions Anatomical changes of duplicate kidney are usually of regular patterns.Making the variations clear is of great importance in improving the diagnosis accuracy and in choosing the treatment strategy.