后尿道瓣膜同时合并前尿道瓣膜的临床诊断决策

Clinical report in treating children with concomitant anterior and posterior urethral valves

目的 探讨如何减少前、后尿道瓣膜同时存在时的漏诊.方法 回顾性分析2010年1月至2015年10月我院3例合并前、后尿道瓣膜患儿的临床资料,并复习国内外类似病例的文献资料.3例均为男性,首次就诊时年龄为3个月、5个月、7个月.后尿道瓣膜切开时年龄分别为3个月、7个月、9个月;前尿道瓣膜切开时年龄分别为6个月、11个月、2岁7个月.首次就诊的主要表现为排尿费力、尿滴沥、尿频、尿不成线及反复出现发热等.首次手术治疗后2例症状缓解不明显,1例排尿困难稍有减轻.结果 3例患儿均是首先发现并切开后尿道瓣膜,术后临床症状改善不明显,再次复查排泄性膀胱尿道造影（voiding cystourethrograms,VCUG）等检查才发现前尿道瓣膜,经膀胱镜将其切开,完全解除梗阻后,临床症状明显改善.结论 对尿道瓣膜治疗后临床症状缓解不明显的患儿及时复查VCUG、尿动力、膀胱镜等检查可避免漏诊合并前、后尿道瓣膜的可能.

Objective To investigate the approach to reduce diagnostic error of concomitant anterior and posterior urethral valves.Methods The clinical data of 3 patients was retrospective analyzed,who was with concomitant anterior and posterior urethral valves admitted from January 2010 to October 2015.The literatures of the similar cases were reviewed.The 3 patients were all male,and the average age was 5 months （3-7 months） at diagnosis.The patients with remaining obstructive symptoms after the release of the posterior urethral valves underwent VCUG,cystoscope,and further surgical treatment for anterior urethral valves.Results Posterior urethral valves were found in all the 3 patients at diagnosis and were fulgurated.However,clinical symptom improvement was not obvious.Anterior urethral valves were indicated by VCUG and then fulgurated in all 3 patients.Thereafter,all clinical symptoms were improved significantly.Conclusions It was necessary to reexamine by VCUG,urodynamics,and cystoscope in the patients without obvious improvement after fulguration of posterior urethral valves,in order to avoid diagnostic error of concomitant anterior and posterior urethral valves.