小儿重复肾畸形的临床分析

目的探讨小儿重复肾畸形的早期诊断和治疗方法。方法回顾分析2003～2010年53例重复肾患者的临床资料,所有例均行B超、IVP检查,35例另行MRU、VCUG检查,确诊52例,29例为重复肾发育不良伴输尿管扩张;18例为重复肾重度积水,其中4例积水伴感染;4例为重复肾轻度积水;1例为发育型重复肾伴下肾积水,定位诊断肾盂输尿管交界处狭窄;误诊为单一输尿管开口异位1例。47例行重复肾重复输尿管切除术,1例行双输尿管整形膀胱再植术,1例行下肾离断性肾盂输尿管成形术,4例为重复肾轻度积水未行手术治疗。结果 48例术后恢复良好,行双输尿管整形膀胱再植术的病例因患侧重复肾反复感染一年后行重复肾切除术,术后恢复良好。结论对于重复肾发育不良及重复肾输尿管扩张的诊断,MRU要优于超声和IVP。重复肾积水多由输尿管远端梗阻所致,重复肾发育不良及重复肾重度积水的治疗以重复肾重复输尿管切除术为首选。

The clinical analysis of children's duplication of kidney

Objective To evaluate the diagnosis and treatment of children’s duplication of kidney and hydronephrosis.Methods The clinical data of 53 cases of children’s duplication of kidney and hydronephrosis between 2003～2010 were analyzed retrospectively.All 53 cases were given intravenous pyelography(IVP) and ultrasonic examinations,35 cases were given magnetic resonance urography(MRU),voiding cystourethrography(VCUG) examinations,52 cases were definitely diagnosed,29 cases were duplicated kidney with ureterectasis;18 cases were duplicated kidney complicated with serious hydronephrosis,with 4 cases of hydronephrosis with infection among them;4 cases were duplicated kidney followed light hydronephrosis;1 case was duplicated kidney with hydronephrosis in lower kidney;1 case was misdiagnosed.47 cases were performed upper nephroureterectomy,1 case underwent ureter-ocystostomy,1 case underwent the Anderson-Hynes operation of the lower kidney,4 cases were duplicated kidney followed light hydronephrosis without treatment.Results 48 cases were cured.1 case who underwent the ureterocystostomy was performed nephrectomy because of repeated infection.Conclusion For diagnosis of ureter and kidney duplication,clinical manifestation plus ultrasonic and IVP examinations are sufficient.For identifying the hydronephrosis causes of ureter and kidney duplication,MRU is superior to ultrasonic and IVP examinations.The ureterocele usually leads to hydronephrosis of the upper kidney,and dysplasia or hydronephrosis of the upper kidney should be performed the upper nephroureterectomy.