离断式肾盂成形术治疗肾盂输尿管连接部梗阻

Treatment of pyeloureteral junction obstruction with mutilate nephropyeloplasty

目的探讨肾盂输尿管连接部梗阻(UPJO)的临床特点及手术方法。方法回顾性分析65例肾盂输尿管连接部梗阻患者,采用离断式肾盂成形术,术中留置双J管,观察治疗效果。结果 65例均行离断式肾盂成形术,术后2例出现急性肾盂肾炎,抗感染治疗后恢复;1例发生漏尿,通过延长腹膜后引流管留置时间,漏尿消失;1例出现再次狭窄,重新放置双J管后好转。随访6个月～2年,平均16个月,B超或IVU检查患侧肾实质明显增厚,输尿管通畅,肾积水消失49例,轻度肾积水14例,中度肾积水2例;患者泌尿系感染、腹部肿物、腰腹部胀痛不适及肉眼血尿等症状消失。结论离断式肾盂成形术是治疗UPJO的经典标准术式,引流可靠,并发症少,费用低,疗效确切。

Objective To investigate the clinical characters and operative methods of pyeloureteral junction obstruction（UPJO）.Methods Retrospectively analyzed 65 patients of UPJO which were treated with mutilate nephropyeloplasty.Results After operation,2 cases appeared acute pyelonephritis and recovered by anti-infective therapy,1 case appeared leakage of urine and recovered by detain post-peritonaeum drainage tube,1case appeared stenosis and improved by place double-J tube again.Followed up from 6 month to 2 years,16 month averagely,renal parenchyma thickened obviously,ureter was unobstructed,and hydronephrosis disappeared in 49 cases,light hydronephrosis in 14 cases,midrange hydronephrosis in 2 cases.Urinary system infection,abdominal mass,pain of waist and abdomen,gross hematuria in patients faded.Conclusions Mutilate nephropyeloplasty is the classic and standard operation for UPJO.It have safe drainage,fewer complications,low expense and good curative effect.