小儿输尿管开口异位所致尿失禁的临床特点分析

Diagnosis and Treatment of Ectopic Ureter as a Cause of Urinary Incontinence in Children

目的 探讨小儿输尿管开口异位所致尿失禁的临床特点。方法 总结25例输尿管开口异位患儿临床资料。本组25例为女性。手术年龄6个月-5岁,平均年龄为2.5岁。肾发育不良合并尿失禁10例,双侧输尿管异位2例,其中1例合并高位无肛;重复肾合并尿失禁13例,左侧重复肾6例,右侧重复肾4例,双侧3例。所有病例均行超声波检查,静脉肾盂造影（IVP）和延迟CT,均行CT三维成像,其中超声波和IVP均未能找到异位开口,而延迟CT结合三维成像对12例患儿提示输尿管开口异位。肾发育不良患儿均行发育不良肾切除术,2例双侧异位输尿管行膀胱输尿管再植术1例,1例放弃治疗。13例重复肾并尿失禁患者,10例上半肾发育不良行上半肾切除术,3例上半肾发育较好,行患侧双输尿管再植术。结果 本组25例患儿无尿失禁、尿路感染等并发症,1例双侧输尿管开口异位并高位无肛放弃治疗。结论 输尿管开口异位多见于女性,最常见原因为重复肾和先天性肾发育不良。延迟CT对于小儿输尿管异位开口的定位诊断意义较大,术前需正确定位,选取恰当的手术方法。

Objective To evaluate the diagnosis and treatment of ectopic ureter in chi ldren. Methods 2 5 cases ofclinical data of children with ectopic ureteral opening. The group of 25 cases were girls, boy. Operation the age 6 months --5year old, average age is 2. 5 years old. Among them, Renal dysplasia with 10 cases of urinary incontinence, bilateral ectopic ureters in 2 cases, duplex kidney and urinary incontinence in 13 cases, 6 cases of left, right and 4 cases of renal duplication, 3 cases of bilateral. All patients underwent ultrasonography, intravenous pyelography （IVP） and delayed CT, underwent CT three -dimensional imaging, including ultrasound and IVP were unable to find ectopic opening, and delayed CT with 3D imaging of 12 patients suggest that ectopic opening of ureter. Renal dysplasia patients underwent dysplasia nephrectomy. 13 cases of duplication of kidney and urinary incontinence, 10 cases of upper renal dysplasia for half nephrectomy, 3 cases of upper renal growth is good, for the ipsilateral ureter reimplantation. Results This group of 25 cases, no in con tinen ce, urinary tract infection and other complications, 1 cases of bilateral ectopic ureteral orifice and anorectal malformation of abandoning treatment. Conclusion delayed CT larger significance for diagnosis of chi ldren with ectopic ureter, preoperative need correct positioning, choose appropriate operation method.