离断倒转肾盂瓣肾盂输尿管成形术治疗长段UPJ狭窄

A modified pyelo-ureteroplasty for congenital hydronephrosis due to long segment of ureter stenosis

目的 探寻有效治疗长段肾盂输尿管连接部 (UPJ)狭窄所致肾积水的术式。 方法 设计肾盂瓣输尿管上段成形术 ,治疗因长段UPJ狭窄所致肾积水病人 2 6例。手术根据UPJ狭窄的长短 ,沿扩张的肾盂纵轴前后剖开至肾盂底部 2 .0～ 2 .5cm处 ,翻转肾盂壁瓣 ,形成新的肾盂及上段输尿管。 结果 随访 1～ 3年 ,术后病人腹部胀痛等症状消失 ,术后 3～ 12个月分别行B超、IVU及逆行肾盂造影 (RP)等检查 ,结果显示肾积水明显减轻 ,吻合口通畅 ,尿常规检查正常。ECT显示患侧 2 0min肾脏排泄率均 >5 0 %。 结论 肾盂瓣输尿管上段成形术治疗长段UPJ狭窄所致肾积水是一种安全有效的新方法。

Objective To evaluate a modified pyelo-u re teroplasty in treating long segment of ureteropelvic junction (UPJ) stenosis. Methods 26 cases were treated with the designed pyelo-ur eteroplasty,on which the dilated pelvic was incised vertically and the pelvic fl ap was turned down to form a new infundibulas tube with running suture and was a nastomosed to the ureter stem,the long stenosis segment being cut off. Results The symptoms vanished in the follow-up period of 1～3 ye ars.It was showed by B-ultrasonography,IVU and RP (retrograde pyelography)that the anastomosis site in all the cases was smooth.3～12 months after operation,G FR(glomerulus filtration rate) was found to be improved markedly,and 20 minutes excretive rate in the operated kidneys was all above 50%. Conclusio ns The troublesome hydronephrosis due to complicated long stenosis o f UPJ and upper ureter can be effectively treated by the modified pyelo-uretero plasty.