肾迷走血管致肾盂输尿管连接部梗阻20例报告

Diagnosis and treatment of ureteropelvic junction obstraction caused by congenital crossing vessels

目的 :探讨肾迷走血管的起源、致病机制及其所致的肾盂输尿管连接部梗阻的诊断与治疗方法。方法 :对 2 0例手术证实为肾迷走血管压迫致肾盂输尿管连接部梗阻的患者的临床资料及预后情况进行回顾性分析。结果 :本病多以肾区间歇性或持续性胀痛、隐痛为首发症状 ,肾盂输尿管连接部带状压迫截断征和输尿管扭转征是本病的较典型影像学征象 ,均伴有不同程度的患侧肾积水 ,手术以选择性保留迷走血管的肾盂输尿管成形术为主 ,术后 2～ 6个月随访 ,1例术后 1个月出现急性肾盂肾炎 ,其余肾脏及输尿管积水均减轻 ;术后 1～ 10年随访 (平均 6 .2年 ) ,除 1例行肾切除术 ,19例患侧肾脏积水均明显减轻 ,肾功能良好。结论 :肾迷走血管经肾盂肾尿管连接部前方或后方进入肾下极者均可造成该处梗阻 ,临床表现无特异性 ,静脉尿路造影、逆行尿路造影及彩色多普勒超声对诊断有较大价值 。

Purpose:To analyse the diagnosis and management of obstruction at uretropelvic junction which caused by aberrant vessel of kidney, and to discuss the source of the aberrant vessel and the mechanism of the disease.Methods:An analyse of history, symptom, examinations, treatment and prognosis of disease was performed in 20 cases of ureteropelvic junction obstraction caused by congenital crossing vessels, who had been improved by operations.Results:The persistent or intermittent secret anguish at kidney were always the primory symptom.The 'string like' compression and break at ureteropelvic junction was one of the main signs of the disease. Different hydronepherosis occured in all cases. Anderson-Hynes operation with selectivly reserving the vessel was the main treatment of this disease. Two to 6 months after operation, hydronepherosis was lightened to different extends in all cases but one. After median follow-up of 6.2 years(range 1 to 10 years), hydronepherosis were evidently lightened and renal function were normal.Conclusions:The lower-pole renal aberrant vessels anteriorly or posteriorly crossing the ureteropelvic junction can induce ureteropelvic junction obstraction. The clinical manifestion is not typical, and sonography, IVU and color Doppler imaging are of great value in the diagnosis of the disease. Anderson-Hynes operation with selectivly reserving the vessel is the first choice of treatment.