小儿先天性肾输尿管畸形并肾积水感染九例误诊分析

Misdiagnosis Analysis of 9 Children with Congenital Kidney and Ureter Malformation Combined with Hydronephrosis

目的探讨小儿先天性肾输尿管畸形并肾积水感染的临床特点、误诊原因及处理方法。方法回顾性分析9例小儿先天性肾输尿管畸形并肾积水感染的临床资料。结果本组主要表现为腰腹痛、发热及尿路刺激征。术前误诊为肾积水7例,肾囊肿2例。4例行肾穿刺造瘘引出脓液而确诊,1例行肾盂输尿管成形术中取肾盂浑浊尿液见脓细胞而确诊,4例经膀胱镜输尿管插管逆行肾盂造影术中引流出脓液而确诊。9例均行手术治疗,其中5例行保肾手术,3例切除患肾,1例双肾积水感染伴慢性肾功能不全仅行肾造瘘术。结论小儿先天性肾输尿管畸形并肾积水感染临床表现无特异性,容易漏误诊。结合病史,及时行B超、静脉尿路造影、泌尿系磁共振尿路造影、CT、弥散加权磁共振成像、肾核素显像及膀胱镜输尿管插管逆行造影等检查,是早期诊断的关键。

Objective To investigate clinical characteristics, misdiagnosed causes and treatment methods of children with congenital kidney and ureter malformation combined with hydronephrosls. Methods Clinical data of 9 children with con- genital kidney and ureter malformation combined with hydronephrosis was retrospectively analyzed. Results Mainly clinical manifestations of these patients were waist and abdomen pain, fever and urinary irritation symptoms. Before operation, 7 chil- dren were misdiagnosed as having hydronephrosis and 2 as having renal cyst. Pyonephrosis was found during kidney paracente- sis and nephrostomy in 4 children, and congenital kidney and ureter malformation combined with hydronephrosis was con- firmed; pus ceils were found in intraoperative sample of turbid urine during pyeloureteroplasty, and the diagnosis was con- firmed; pyonephrosis was found during retrograde pyelography draining by intra-ureteral cannula under cystoseopes in 4 pa- tients, and the diagnosis was confirmed. All the 9 children underwent surgery, among whom 5 children underwent nephron sparing surgery, 3 children underwent resection for pyonephrosis, and nephrostomy was performed for 1 patient with bilateral pyonephrosis associated by chronic renal insufficiency. Conclusion Clinical manifestations of congenital kidney and ureter malformation combined with hydronephrosis are lack of specific, and therefore it is easy to miss diagnosis and misdiagnosis. It is the key points for early diagnosis by performing B ultrasonography, intravenous urography, magnetic resonance urography, CT, diffusion weighting magnetic resonance imaging and retrograde radiography examination in time combined with medical history.