小儿输尿管膨出症的治疗

目的探讨各种方法治疗输尿管膨出症的疗效,寻找影响预后的有关因素。方法 31例输尿管膨出症,男4例,女27例;左侧15例,右侧12例,双侧4例。其中单一输尿管膨出2例,重肾并输尿管膨出29例。VCU检查18例,3例发现中—重度反流,31例均行超声和IVU及CT检查。结果术后随访0.5～3 a,2例单一输尿管膨出症行膨出切除输尿管膀胱再植术,29例重肾中,4例经膀胱行输尿管膨出切除输尿管膀胱再植术。3例中—重度反流,2例行输尿管膨出切除加上半肾切除术,1例行上半肾切除术,术后因反流持续存在,需再次手术;其余22例均行上半肾切除术,术后2例因严重尿路感染行输尿管残端切除术。结论输尿管膨出的治疗应根据输尿管膨出的类型、肾功能、有无反流决定手术方式,对于大多数重肾,单纯上半肾切除预后良好,若术前VCU检查有中—重度返流,应行完全重建术。

the Treatment of ureterocele in children

Objective To evaluate the choice of operative procedures for ureterocele,and identify factors relate to the outcome.Methods 31 patients with ureterocele were studied,male 4,female 27,include 15 left upper,12 right upper and 4 bilateral upper ureterocele.24 patients had duplex kidneys associated ureteroceles,2 patients had ureteroceles without duplex kidney.18 patients underwent VCU examination,3 cases detected middle-high grade vesicoureteral reflux.31 patients were confirmed by ultrasound and IVU examinations.Results 31 patients were followed-up for 6 months to 3 years.①2 patients with single system received ureterocelectomy and ureteral reim plantation.②Of 29 patients with duplex system,2 patients underwent ureterocele excision with ureteral reimplantation,2 patients underwent complete reconstraction of 3 vesicoureteral reflux,another one later required reoperation for persistent symptomatic reflex,of the remaining 24 patients underwent upper pole heminephrectomy,2 patients required resection of the ureteral stump remnant for urinay infection.Conclusion In patients with ureterocele.The type,nonfunctioning kidney,preoperative vesicoureteral reflux should be considered as the treatment of choice.The primary upper pole heminephrectomy is a favorable alternative in the majority of duplex kidneys.The definitive reconstruction is preferable in the patients with preoperative middle-high grades vesicoureteral reflux.