经膀胱镜输尿管双J管置入治疗小儿上尿路梗阻

Therapeutic Effect of Transurethral Ureteral Double J Stent Placement in Children With Upper Urinary Tract Obstruction

目的探讨经膀胱镜留置输尿管双J管在小儿上尿路梗阻中的应用价值。方法回顾性分析2014年12月~2018年5月45例膀胱镜输尿管双J管置入治疗上尿路梗阻的资料,其中先天性肾积水20例,急性输尿管结石梗阻23例,肾盂离断成形术后积水复发2例。均经膀胱镜逆行置入F3、F4或F4.7双J管。结果2例先天性肾积水和3例急性输尿管结石梗阻未能置入输尿管双J管,其余40例留置双J管位置良好。先天性肾积水18例均于术后6个月取出双J管,8例随访3~4年积水未加重,10例因积水加重行腹腔镜肾盂离断成形术;急性输尿管结石梗阻20例于1~2周拔除输尿管双J管,二期输尿管镜钬激光碎石成功;肾盂离断成形术后积水复发2例均于术后6个月拔除输尿管双J管,1例随访1年5个月肾积水无再次加重,1例因肾积水再次加重于拔管后20天行腹腔镜肾盂离断成形术。结论输尿管双J管置入可有效缓解小儿上尿路梗阻,达到缓解肾脏压力的目的,可作为婴幼儿和儿童上尿路梗阻的一线治疗方案。

Objective To explore the application value of transurethral uretera double J stent placement in children with upper urinary tract obstruction.Methods A retrospective analysis was made on 45 children with upper urinary tract obstruction who underwent cystoscopic ureteral double J stent placement in our hospital during December 2014 to May 2018.There were 20 children with congenital hydronephrosis,23 children with acute ureteral calculi obstruction,and 2 patients with recurrent hydronephrosis after pyeloplasty.All the children were given retrograde placement of F3,F4 or F4.7 double J stent through cystoscopy.Results Two children with congenital hydronephrosis and three children with calculi failed to place double J stent in the ureter,and the remaining 40 cases were successfully operated.In 18 cases of congenital hydronephrosis,double J stents were removed after 6 months.Among them,8 cases were not aggravated after 3-4 years of follow-up,and 10 cases underwent laparoscopic pyeloplasty dissection due to aggravation of hydronephrosis.In 20 cases of acute ureteral calculi obstruction,double J stents were removed after 1-2 weeks.And then they were treated with two-stage ureteroscopy holmium laser lithotripsy.In 2 cases of hydronephrosis recurrence after pyeloplasty,double J stents were removed after 6 months.One case had no further aggravation of hydronephrosis after follow-up for 1 year and 5 months,while the other case underwent laparoscopic pyeloplasty after 20 days due to hydronephrosis aggravation again.ConclusionsTransurethral ureteral double J stent placement can effectively alleviate upper urinary tract obstruction in children and achieve the purpose of relieving renal pressure.It can be used as a first-line treatment option for upper urinary tract obstruction in infants and children.