成人肾盂输尿管连接部梗阻的手术治疗

Operative treatment of ureteropelvic junction obstruction in adults

目的 总结成人肾盂输尿管连接部梗阻的诊治经验。方法 对我院 1990年 7月至 2 0 0 3年 6月收治的 5 6例成人肾盂输尿管连接部梗阻患者的病因、诊断及治疗结果进行回顾性分析。结果 肾盂输尿管连接部狭窄引起梗阻者 46例 ( 82 .1% ) ,其中 3例为双侧 ;粘连带压迫者 3例 ( 5 .3 % ) ,输尿管肾盂高位连接者 4例次 ( 7.3 % ) ,异位血管压迫者 3例次 ( 5 .3 % )。共行手术 5 9例次 ,Anderson Hynes离断式肾盂成形术 47例次 ,肾盂Y V成形术 4例 ,纤维条索松解 3例 ,异位血管切断 3例 ,肾切除术 2例。本组病例除 2例肾切除者外 ,余 5 4例均于术后 3个月至 1年进行复查随访 ,5 0例痊愈。总治愈率 92 .8%。 4例 ( 7.2 % )发生再狭窄 ,二次行肾盂成形术后均痊愈。结论 IVU和RU是诊断成人肾盂输尿管连接部梗阻的主要方法 ,Anderson Hynes离断式肾盂成形术是治疗成人肾盂输尿管连接部梗阻的首选术式。

Objective To summarize the experience in the treatment of ureteropelvic junction obstruction in adults. Methods The clinical data including etiology, diagnosis, and outcomes of surgery from 56 adult patients with ureteropelvic junction obstruction admitted to our hospital from 1990 to 2003 were analyzed retrospectively. Results Etiological factors included ureteropelvic junction stricture in 46 cases (82.1%, bilateral in 3 cases), fiber chords in 3 cases (5.3%), high location of the junction in 4 cases (7.3%), and ectopic vessels in 3 cases (5.3%). A total of 59 cases-times of surgical procedures were performed, including 47 cases-times of Anderson-Hynes pelvioplasty, 4 cases-times of Y-V pyeloplasty, 3 cases-times of chord brisement, 3 cases-times of ectopic vessel resection, and 2 cases-times of nephrectomy. After a follow-up of 54 patients for 3 months to 12 months, complete recovery was found in 50 patients with a cure rate of 92.8%, and 4 patients underwent Anderson-Hynes pelvioplasty again due to stricture recurrence. All the patients with recurrence were completely cured. Conclusion Intravenous urography (IVU) and retrograde ureteropyelography (RU) are the two main methods for the diagnosis of ureteropelvic junction obstruction in adults. Anderson-Hynes pelvioplasty is the first choice for the treatment of ureteropelvic junction obstruction in adults.