先天性梗阻性巨输尿管的诊断治疗

Diagnosis and treatment of primary obstructive megaureter

目的探讨先天性梗阻性巨输尿管症的诊断、手术治疗方法。方法本研究报告25例先天性梗阻性巨输尿管症患者,其中双侧肾积水7例,左侧积水13,右侧5例;2例患者行肾切除手术,其余23例行有经膀胱外输尿管移植术。结果患者术后随访3～6个月,静脉肾盂造影示,23例行输尿管膀胱再植肾积水均见好转,2例有输尿管反流到输尿管中段。结论静脉肾盂造影、CT尿路成像和MRU检查是先天性巨输尿管症的首选检查方法。治疗原则是解除梗阻,保留肾功能。手术方式经膀胱外输尿管移植术。

Objective To explore the diagnosis and treatment of the congenital obstructive megaureter. Methods A total of 25 pa- tients with the congenital obstructive megaureter were presented. 13 patients were left megaureter, 5 patients were right megaureter and 7 pa- tients were bilateral megaureter. Our sample comprised of 21 men and 4 women,with an average age of 21 （range 1 -65 year）. 23 patients were treated by reimplantation with Lich - Gregoir technique, and 2 patients were treated by total renoureterctomy. Results 25 patients were followed up for 3 - 6 months. 2 patients underwent unilateral ureter and kidney resected, and 23 patients underwent ureterovesical reimplanta- tion. The hydronephrosis and hydroureter of the operated side reduced. Conclusion IVU, CTU and MRU are the primary examination meth- ods for the primary obstructive megaureter, the principle of treatment for which is to relieve the obstruction and preserve the renal function. The ureterocystanastomosis is the main choice.