儿童重复肾重复输尿管畸形118例临床分析

Clinical analysis of 118 cases of duplication of kidney and ureter in children

目的探讨儿童重复肾重复输尿管畸形的临床特点及治疗方案,为临床诊治提供依据。方法回顾性分析2015年1月至2019年6月在深圳市儿童医院泌尿外科手术治疗的118例(男性32例,女性86例)重复肾重复输尿管畸形患儿的临床资料。结果患儿的临床表现以发热、尿失禁最常见(82.2%),腹部肿物及腰肋部不适少见;111例患儿术前经影像学检查明确诊断(7例行输尿管逆行造影术),合并输尿管异位开口39例,输尿管囊肿38例,膀胱输尿管反流11例;腹腔镜重复肾重复输尿管切除术<1岁组22例(A组)、1~3岁组42例(B组)、>3岁组18例(C组);C组平均手术时间短于A组和B组,C组术中出血量少于A组,差异均有统计学意义(P<0.05);所有患儿无正常肾单位丢失,术后复查超声均获得满意结果;随访时间平均18个月,115例患儿术后恢复良好,2例输尿管囊肿开窗引流术后和1例输尿管端侧吻合术后因反复感染、肾积水加重且功能受损后再入院行输尿管膀胱再植。结论重复肾重复输尿管患儿临床表现以发热、尿失禁最常见。本病合并畸形各异,宜根据重复肾肾功能制定个体化治疗,术后中远期疗效确切。

Objective To investigate the clinical characteristics and treatment of duplication of kidney and ureter in children,and to provide basis for clinical diagnosis and treatment.Methods The clinical data of 118 cases(32 males and 86 females)with duplication of kidney and ureter treated in Department of Urinary Surgery,Shenzhen Children's Hospital from January 2015 to June 2019 were retrospectively analyzed.Results Fever and urinary incontinence were the most common clinical manifestation(82.2%),while abdominal mass and lumbar costal discomfort were rare.A total of 111 children were diagnosed by preoperative imaging(7 cases underwent retrograde ureterography),and there were 39 cases with ectopic ureteral opening,38 cases with ureteral cyst,and 11 cases of bladder and ureter reflux.The patients were divided into three groups according to laparoscopic heminephroureterectomy group A(22 cases,<1 year old),group B(42 cases,1~3 year old)and group C(18 cases,>3 years old).The average operative time in group C was shorter than that in group A and group B,and group C had less intraoperative bleeding than group A,with statistically significant difference(P<0.05).All children had no loss of normal renal units,and satisfactory results were obtained by ultrasonography.The average follow-up time was 18 months.A total of 115 cases recovered well after operation,while 2 cases of ureterocele fenestration drainage and 1 case of ureteral end-to-side anastomosis were hospitalized for ureter bladder replantation because of repeated infection,aggravation of hydronephrosis and functional impairment.Conclusion Fever and urinary incontinence are the most common clinical manifestations in children with duplication of kidney and ureter.It is suggested that individualized treatment should be made according to the renal function of repeated kidney,which shows outstanding effect on the sanatory rdhabilitation in the mid to long term.