小儿重度肾积水术式选择及疗效观察

The Selection of Surgical Method and Therapeutic Effect of Severe Hydronephrosis in Children

探讨小儿重度肾积水手术方案的选择，随访并评价术后疗效。回顾性总结我科2009年6月-2012年6月诊治并行手术治疗的肾盂输尿管连接部梗阻致小儿重度肾积水50例的临床资料并术后定期随访。46例行首次离断式肾盂成形术后疗效满意。2例首次术后恢复差，再次行肾盂成形术治愈。1例肾穿刺造瘘后肾萎缩行肾切除。1例合并输尿管膀胱连接部狭窄，1个月后行输尿管膀胱再植术治愈。术后2年获访45例，获访患儿尿常规均正常，彩超提示积水≤3级，分肾功能平均值为45．26％。确诊存在器质性梗阻的重度肾积水患儿，应尽早手术干预，严格掌握I期肾盂成形术、肾造瘘术及肾切除的手术指征。

To discuss the selection of surgical treatment plan of severe hydronephrosis in children ,the authors followed up and evaluated the postoperative effect .50 cases of severe hdronephrosis of children who were operated between Jun .2009 and Jun .2012 were retrospectively analyzed ,and they were followed up regularly after operation .46 cases who were operated with pyeloplasty got satisfactory effect ,2 cases recovered badly after the first operation and were cured by second operation .1 case developed renal atrophy after nephrostomy and his renal was excised .1 case combined with stenosis of ureterovesical junction was cured by ureterovesical implantation .45 cases were followed up 2 years after operation , urinalysis was normal ,the hydronephrosis of each patient was ≤ grade 3 ,split renal function was 45 .26% .Once the diagnosis of severe hydronephrosis is caused by organic obstruction ,early surgical treatment should be implemented .To strictly control the surgical indications of I stage nephropyeloplasty ,nephrostomy and renal excision .