腹腔镜治疗马蹄肾肾积水3例并文献复习

Hydronephrosis of horseshoe kidney under laparoscopy and literature review 3 cases

目的探讨马蹄肾(HSK)合并肾积水的病因、诊断和腹腔镜治疗方法,提高对此类疾病的认识水平。方法回顾性分析2019-06—2020-06郑州大学第一附属医院小儿外科行腹腔镜治疗的3例HSK合并肾积水患儿的临床资料,并对相关文献进行复习。结果3例患儿中,1例为异位血管压迫、肾盂高开口导致的双侧肾积水,1例为输尿管与峡部粘连引发的左侧肾积水术后效果不佳,1例为肾盂输尿管连接部狭窄造成的左肾积水。3例均顺利行腹腔镜离断式肾盂成形术,未发生近期及与远期并发症。拔除双J管后1个月行泌尿系统超声检查,肾盂平均回缩值为19.75 mm,较术前的31.25 mm明显改善,差异有统计学意义(P<0.05)。检索到中文文献5篇(35例),英文文献9篇(36例),各有1篇病例系列报道,对收集到的文献进行分析总结。结论HSK伴肾积水十分罕见。离断式肾盂成形术是主要的术式。虽然复杂的解剖异常给腔镜手术带来困难,但腹腔镜离断式肾盂成形术仍是安全可靠的。详细的术前检查,可以明确HSK的解剖结构、预估梗阻原因和选择合适手术方案,这对手术的顺利进行有重要临床价值。

Objective To explore the etiology,diagnosis and laparoscopic treatment of horseshoe kidney(HSK)complicated with hydronephrosis,and to raise awareness of such diseases.Methods We retrospectively analyzed the data of 3 cases of horseshoe kidney with hydronephrosis admitted to the First Affiliated Hospital of Zhengzhou University from June 2019 to June 2020,and reviewed and analyzed relevant literature.Results The causes were different.One case was bilateral hydronephrosis(heterotopic vascular compression,high renal pelvis opening),and one case of left hydronephrosis had poor effect after surgery(ureter and isthmus adhesion),another case was left hydronephrosis(ureteropelvic junction stenosis),but all underwent laparoscopic disconnected pyeloplasty.The intraoperative anatomy was careful and the operative went smoothly.There were no short-term and long-term complications after the operation.All children were rechecked with urinary system B-mode ultrasonography one month after the removal of the double J tube.The average pelvic retraction of the renal pelvis was 19.75 mm,which significantly improved from 31.3 mm before operation,and the difference was statistically significant(P<0.05).5 Chinese documents(35 cases)and 9 English documents(36 cases)were retrieved.Among them,there is a case series report in both Chinese and English documents.The collected documents are analyzed and summarized.Conclusion Horseshoe kidney with hydronephrosis is very rare.Disconnected pyeloplasty is the main surgical method for treatment.Although complicated anatomical abnormalities bring difficulties to laparoscopic surgery,laparoscopic disconnected pyeloplasty is still safe and reliable.A detailed preoperative examination can clarify the anatomical structure of the horseshoe kidney,estimate the cause of the obstruction and choose an appropriate surgical plan,which is essential for the smooth progress of the operation.