儿童输尿管髂血管水平梗阻诊治分析

Diagnosis and management of ureteral obstruction at the level of iliac vessel

目的探讨儿童输尿管髂血管水平梗阻的治疗特点。方法收集2009年1月至2020年11月首都医科大学附属北京儿童医院收治的29例输尿管髂血管水平梗阻患儿的临床资料。其中男19例,女10例,中位年龄5.4岁,年龄范围0.5~14岁。29例术前均行泌尿系统超声检查及静脉肾盂造影,排尿性膀胱尿道造影6例,肾核素扫描10例,磁共振尿路成像(magnetic resonance urography,MRU)3例。腹腔镜手术6例,均为输尿管狭窄切除+端端吻合术;开放手术23例,其中3例合并肾盂输尿管连接部梗阻者不同期行肾盂成形术。结果26例获得随访,3例失访,中位随访时间12个月,随访时间范围6~96个月。除发育不良肾切除术1例外,术后复查影像均显示肾积水好转,患侧肾功能良好,术前合并腹痛、泌尿系感染患儿术后症状消失。结论输尿管髂血管水平梗阻可合并输尿管近端、远端狭窄或肾脏畸形,术前应依据超声、MRU了解肾脏形态及梗阻点位置,肾核素扫描和静脉肾盂造影了解肾脏功能,必要时行输尿管逆行造影了解梗阻点及输尿管发育情况。经手术治疗,预后好。

Objective To explore the diagnosis and management of ureteral obstruction at the level of iliac vessel.Methods From January 2009 to December 2020,retrospective review was performed for clinical features,diagnoses and surgical managements of 29 surgical children of ureteral obstruction at the level of iliac vessel.There were 19 boys and 10 girls with an average age of 5.4(0.5-14)years.IVP was performed.The relevant examinations included voiding cystourethrography(VCU)(n=6),renal scan(n=6)and magnetic resonance urography(MRU,n=3).And the procedures were laparoscopic ureteroureterostomy(n=6),open surgery(n=23),pyeloplasty plus ureteroureterostomy for mid-ureteral stricture and ureteropelvic junction obstruction(UPJO,n=3).Results During a median follow-up period of 12(6-96)months,3 children became lost and the remainders were tracked.Except for one case of nephrostomy,there were a marked relief of hydronephrosis and an improvement of split-renal function.No urinary tract infection occurred after operations.Conclusion Ureteral obstruction at the level of iliac vessel is frequently accompanied by other urological abnormalities.Utrasound and MRU may be employed for determining the anatomy of urinary system and pinpointing the location of ureteral obstruction.And IVP and renal scan hint at renal function.After surgical intervention,clinical prognosis is generally decent.