儿童先天性肾盂输尿管连接部梗阻的腔内泌尿外科处理

Endoscopic Management of Congenital Ureteropelvic Junction Obstruction in Children

目的 研究小儿先天性肾盂输尿管连接部梗阻 (UPJO)的腔内泌尿外科处理的可行性与疗效。 方法 2 0 0 0年 1月～ 2 0 0 2年 12月利用逆行气囊扩张、经皮肾顺行电刀与钬激光内切开两种方法 ,治疗 5～ 14岁UPJO患儿 2 2例 ,逆行气囊扩张 14例 ,电刀与钬激光内切开 8例。 结果 术后随访 3～ 2 6月 ,总有效率为 86 % (19/ 2 2 )。其中 1例顺行电刀内切开疗效不明显 ,改开放手术证实为UPJ异位血管压迫 ;2例气囊扩张 2次后疗效不明显 ,经顺行电刀与钬激光内切开。除经皮肾顺行电刀与钬激光内切开 8例患儿 ,术后 1～ 2d有轻微发热与患侧腹痛外 ,其余未出现并发症。

Objective To investigate the feasibility of endoscopic treatment for congenital ureteropelvic junction obstruction (UPJO) in children. Methods From January 2000 to December 2002, 22 children with congenital ureteropelvic junction obstruction, aged from 5 to 14, underwent percutaneous antegrade endopyelotomy or balloon dilation. Result All cases were followed up for 3 to 26 months. The overall success rate was 86%(19/22). One uncured patient of antegrade electrocautery endopyelotomy was proven to be a crossing vessel during Anderson-Hynes pyelotomy. Two of repeated balloon dilation were later cured by antegrade electrocautery or laser endopyelotomy. Mild fever in postoperative 1～2 days and affected abdominal pain occurred in 8 cases of antegrade electrocautery or laser endopyelotomy.But no major complications occurred in all patients. Conclusion Endoscopic management of pediatric congenital ureteropelvic junction obstruction is safe and effective.