肾盂输尿管成形术及其辅助治疗

Pyeloureteroplasty and the adjuvant procedures for the treatment of pelvic-ureteral junction obstruction

目的 探讨肾盂输尿管连接部 (UPJ)梗阻的最佳治疗方案。方法 报告 6 3例 (70侧 )UPJ梗阻的治疗情况 ,48侧行Anderson Hynes肾盂成形术 ,其中 8例巨大及重度肾积水者加作肾内翻折叠及肾固定术 ,6侧行肾盂瓣输尿管成形术 ,5侧行Y V成形术 ,11侧行肾切除术。全部病例均放置输尿管支架引流 ,其中 11例患儿应用改良式双J管内引流。 结果 48侧行Anderson Hyres肾盂成形术者术后复查IVU显示肾盂明显缩小 ,肾功能改善 ,UPJ处蠕动良好 ,1例吻合口处狭窄 ,扩张后再次放置双J管 8周后治愈。 6侧行肾盂瓣成形术及 5侧行Y V成形术者术后复查肾积水有改善 ,但肾盂缩小不明显 ,UPJ处蠕动幅度、频率改善不明显。 11侧应用改良双J管的患儿术后 4周门诊拔管 ,均获治愈。住院时间由以往外引流的 18～ 2 0d缩短至 6～ 7d。 5 1例随访 6个月～ 5年 ,1例吻合口处狭窄者扩张置管后治愈 ,余无复发。 结论 Anderson Hynes肾盂成形术为最佳术式。巨大肾积水者行Anderson Hynes肾盂成形术加肾内翻折叠及肾固定术不仅改善外观 ,更利于引流及功能恢复。

Objective To probe into the surgical treatment for pelvic ureteral junction obstruction (PUJO). Methods Of the 63 cases (70 sides) of PUJO,48 have been treated by Anderson Hynes pyeloplasty,6 by pelviflapureteroplasty,5 by Y V pyeloplasty and in 11 nephrectomy being undertaken.Nephroplication and nephropexy adjuvant to A H pyeloplasty have been performed in 8 cases with severe hydronephrosis with an ureteral stent for drainage.Double J catheters for internal drainage have been used for 11 children. Results 51 patients have been followed up for 1/2 to 5 years,a complete cure being observed in all.Stenosis at the anastomosis site has been observed in 1 patient which was successfully treated by dilatation and stenting. Conclusions A H pyeloplasty is believed to be the best approach and for severe hydronephrosis nephroplication and nephropexy would help the drainage and promote the recovery of renal function.Double J catheter may be used in children.