单纯上或下患肾部输尿管膀胱外再植治疗完全性重复肾畸形

Application of upper or lower pole ureter dismembered extravesical reimplantation in children with cOmplete duplex kidney

目的评价采用单纯上或下患肾部单根输尿管膀胱外再植治疗完全性重复肾畸形的疗效。方法从2009年12月1日起至2014年12月31日间，我科采用单纯上或下患肾部单根输尿管膀胱外再植治疗完全性重复肾畸形患儿27例，均为单侧病变，女19例，男8例，年龄2个月至8岁：所有患儿经影像学检查明确诊断为完全性重复肾畸形且均为单根输尿管病变。其中上输尿管异位开口者9例；重复上肾上输尿扩张积水伴上输尿管末端囊肿者10例；重复下肾部输尿管单纯反流者8例。临床症状主要表现为正常排尿间歇性滴尿或发热性尿路感染。所有患儿术后随访观察11个月至6年，随访项目包括泌尿系统超声、同位素和膀胱造影等。结果所有患儿手术过程顺利，平均手术时间63min，术后平均住院时间为5d，术后所有患儿临床症状均消失。术后有1例患儿因血尿检查发现再植输尿管开口处结石形成，予以行膀胱镜下钬激光碎石术。术后6个月复查超声示患肾部积水均有好转，同位素示患肾部功能改善或稳定，正常肾部功能未见异常改变。7例患儿术后复查排泄性膀胱尿道造影检查未见膀胱输尿管反流等发生。结论经腹股沟皮纹小切口单纯上或下患肾部单根输尿管膀胱外再植术治疗完全性重复肾畸形是一种安全、有效的方法，值得临床推广。

Objective To explore the efficacy of upper or lower pole ureter dismembered extravesical reimplantation in the treatment of complete duplicated collecting systems. Methods Between December 2009 and December 2014, 27 cases of complete duplex kidney were operated by upper or lower pole ureter dismembered extravesical reimplantation. There were 19 girls and 8 boys with an average operative age of 25.2 （2-96） months. All of them were diagnosed as complete duplication anomalies with single ureteral pathological changes by preoperative iconography. There were ectopic ureter （n = 9）, ureteroceles （n = 10） and lower pole vesicoureteral reflux （n = 8）. The major clinical symptoms included urinary dripping, fever and urinary tract infection. The postoperative follow-up period was 11-72 months. Renal sonography, excretory urography, radionuclide scanning and voiding cystourethrography were performed. Results All operations were successful. The average operative duration was 63 minutes and mean length of hospital stay 5 days. And 27 cases had a resolution of preoperative symptoms disappeared after operation. One case of postoperative hematuria due to ureteral calculus in ureter bladder anastomosis was managed by holmium laser lithotripsy through cystoscopy. After operation, all renal functions improved or stabilized. Postoperative follow- up voiding cystourethrogram showed no vescoureteral reflux in 7 cases. Conclusions Inguinal approach to upper or lower pole ureter dismembered extravesical reimplantation is safe, efficacious and well- tolerated for children with duolicated collecting systems. And it is worthy of wider popularization.