孤立肾并肾盂输尿管连接部梗阻的手术疗效分析

Effect of surgical treatment of solitary kidney with ureteropelvic junction obstruction

目的了解孤立肾合并肾盂输尿管连接部梗阻(UPJO)的手术治疗时机对于肾功能的影响。方法回顾性分析2006年1月至2018年1月首都医科大学附属北京儿童医院和北京儿童医院顺义妇儿医院收治的孤立肾合并UPJO 23例患儿临床资料。其中男16例,女7例。首诊年龄为1 d~15岁8个月,平均2岁2个月。全组患儿平均保守治疗时间2年9个月。应用SPSS 20.0软件进行统计学分析。结果23例患儿均接受离断性肾盂成形术(A-H术),手术时年龄10个月~16岁4个月,平均4岁11个月。<1岁者2例,分别为10个月、11个月。术后保留双J管2个月,术后3个月时复查静脉肾盂造影(IVP),显示肾盂积水较前无明显变化或不同程度减轻;3例术前IVP 40 min仍不显影者,术后显影明显改善,在10~20 min时显影。随访1年1个月~10年,平均随访3年9个月,泌尿系统超声提示肾盂扩张程度较术前有不同程度减轻。结论孤立肾并UPJO在严密观察下的密切随访及保守治疗至6个月以后是安全的,首选手术方式为肾盂离断成形术。

Objective To investigate the effect of timing of surgical treatment on renal function of children with solitary kidney and ureteropelvic junction obstruction(UPJO).Methods The clinical data of patients with solitary kidney and UPJO admitted to Beijing Children′s Hospital,Capital Medical University and Shunyi Women′s and Children′s Hospital of Beijing Children′s Hospital from January 2006 to January 2018 were retrospectively analyzed.A total of 23 cases were enrolled,including 16 males and 7 females.The age of first visit ranged from 1 day to 15 years and 8 months(average:2 years and 2 months).All the patients were conservatively treated for an average of 2 years and 9 months.SPSS 20.0 software was used for data analysis.Results All patients received Anderson-Hynes pyeloplasty(A-H operation),and the age at operation ranged from 10 months to 16 years and 4 months,with an average of 4 years and 11 months.There were only 2 cases under 1 year old(10 months old and 11 months old,respectively).The double J stent was retained for 2 months after operation,and intravenous pyelography(IVP)was reexamined at 3 months after operation.The results showed that hydronephrosis either had no obvious change or was alleviated in different degrees.In 3 cases,IVP remained undetected for 40 minutes before operation.After operation,IVP was detected at 10-20 minutes.The follow-up period ranged from 1 year and 1 month to 10 years,with an average of 3 years and 9 months.Urinary ultrasound showed that the degree of pyeloplasty was less severe than that before operation.Conclusions Close follow-up visits and conservative treatment of solitary kidney with UPJO are safe after 6 months.The first choice of operation is pyeloplasty.