先天性巨输尿管症的临床诊治探讨:附14例报告

The diagnosis and treatment of congenital megaureter: report of 14 cases

目的探讨先天性巨输尿管症的诊断及治疗方法。方法回顾性分析14例先天性巨输尿管症的临床资料,其中左侧6例,右侧5例,双侧3例,均经超声、KUB+IVP、膀胱镜逆行插管造影、CT、MRU等检查确诊。采用输尿管中、下段裁剪、抗返流输尿管膀胱再植术9例,因肾重度积水、功能严重受损而行肾、输尿管切除术2例,1例行输尿管末端切开术,2例行保守治疗,定期更换双J管。结果行输尿管膀胱再植术9例(包括先行肾盂穿刺造瘘术,3个月后再行输尿管膀胱再植术的患者),均于6～12周后拔除支架管或双J管。术后随访1～3年,经超声及IVP检查,显示患侧输尿管扩张均明显减轻,1例肾积水缓解不明显,于随访后第3年行肾输尿管切除术。输尿管末端内切开术患者在术后1年内复诊更换双J管2次,复查超声提示肾积水明显减轻。保守治疗的2例患者到目前为止,病情无恶化征象。结论超声和KUB+IVP检查是诊断先天性巨输尿管症的首选检查方法,但MRU和CTU近年体现出更多的诊断优势。随着泌尿外科腹腔镜和输尿管镜等腔镜技术的发展和提高,采用腔镜技术治疗也将是必然趋势。

Objective To investigate the diagnosis and treatment of congenital megaureter.Methords Fourteen cases of congenital megaureter including 6 cases on the left,5 cases on the right and 3 bilateral cases were retrospectively analyzed.Diagnosis were confirmed by ultrasound,KUB ＋IVP,retrograde ureterography,CT and MRU.Anti-reflux ureteral reimplantation with ureteral clipping was performed in 9 cases,2 cases of nephrostomy for 3 months in prior,nephroureteroctomy in 2 cases due to severe renal functional impairment,and endoincision of the distal ureter in 1 case.The other 2 cases were treated conservatively by periodic replacement of double-J stent.Results In the 9 cases of ureteral reimplantation double J stents were removed in 6 to 12 weeks.Patients were followed up by ultrasound and IVP and that showed dilation of ureter and hydronephrosis were significantly improved in 8 cases,but failed in the other case who underwent nephroureteroctomy in 3 years.The 1 case of endoincision of distal ureter showed improvement of hydronephrosis 1 year after replacement of double-J stent.The 2 cases of conservative treatment showed no signs of exacerbation.Conclusion Ultrasound and IVP are recommended in the diagnosis of congenital megaureter,but CTU and MRU show more diagnostic advantage.Main surgical treatment is ureter reimplantation,and the endoscopic surgery has gradually taken place.