小儿先天性肾盂输尿管连接部梗阻诊治265例
- 摘要:
- 目的探讨离断性肾盂成形术在小儿先天性肾盂输尿管连接部梗阻中的治疗效果。方法总结2006年至2007年收治的265例小儿先天性肾盂输尿管连接部梗阻患儿的临床资料。男226例,女39例。左侧183例,右侧65例,双侧17例。平均年龄4.5岁,其中年龄小于1岁34例。根据症状、超声、静脉尿路造影(IVU)或核磁水成像明确诊断,对重度肾积水患儿行肾核素扫描了解分肾功能。均行腹部横行小切口离断性肾盂成形术(Anderson-Hynes术式)。结果术后随访6个月,以梗阻症状消失、肾盂变窄或肾实质增厚为治愈标准。病理诊断:肾盂输尿管连接部狭窄并高位输尿管最多见,占93.2%。265例(282侧)一次手术成功率为98.5%。结论新生儿肾积水多为生理性,有自行改善的可能,绝大多数不需要手术治疗。小儿先天性肾盂输尿管连接部梗阻的首要病因是肾盂输尿管连接部狭窄。有明显梗阻症状、肾盂进行性扩张或肾功能损害进行性加重者需手术治疗,首选离断性肾盂成形术。
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[1]杨洋 张潍平 彭芸 温洋 杨吉刚.两种输尿管不全梗阻肾积水动物模型制作方法的比较[J].临床小儿外科杂志,2011,10(02):107.
Comparison of two different methods to establish animal model of hydronephrosis due to incomplete ureteral obstruction.[J].Journal of Clinical Pediatric Surgery,2011,10(06):107.
[2]杨星海,杨小红,丁峰,等.肾积水的产前诊断及预后分析[J].临床小儿外科杂志,2008,7(05):1.
[3]张丽瑜,夏慧敏,余家康,等.维甲酸导致胎鼠肾积水的实验研究[J].临床小儿外科杂志,2007,6(02):4.
[4]刘 芳 杨文忠 袁先宏 杨星海.产前ＭＲＩ在评估胎儿中重度肾积水中的作用探讨[J].临床小儿外科杂志,2018,17(01):23.
Liu Fang,Yang Wenzhong,Yuan Xianhong,et al.The role of prenatal MRI in evaluating fetal moderatetosevere hydro nephrosis.[J].Journal of Clinical Pediatric Surgery,2018,17(06):23.
[5]张君颀,耿红全.肾积水患儿的肾功能评估与结局预判[J].临床小儿外科杂志,2020,19(03):193.[doi:10.3969/j.issn.1671-6353.2020.03.001]
Zhang Junqi,Geng Hongquan.Recent advances in renal function evaluation and outcome prediction of pediatric hydronephrosis[J].Journal of Clinical Pediatric Surgery,2020,19(06):193.[doi:10.3969/j.issn.1671-6353.2020.03.001]
[6]马睿.儿童肾积水的影像学诊断策略[J].临床小儿外科杂志,2020,19(03):199.[doi:10.3969/j.issn.1671-6353.2020.03.002]
Ma Rui.Imaging-based diagnostic strategies of pediatric hydronephrosis[J].Journal of Clinical Pediatric Surgery,2020,19(06):199.[doi:10.3969/j.issn.1671-6353.2020.03.002]
[7]严兵,张黄成昊,唐浩宇,等.开放小切口Anderson-hynes术治疗小儿肾积水83例疗效分析[J].临床小儿外科杂志,2020,19(05):432.[doi:10.3969/j.issn.1671-6353.2020.05.011]
Yan Bing,Zhanghuang Chenghao,Tang Haoyu,et al.Analysis of curative efficacy for open small incision Anderson-Hynes treatment of children with hydronephrosis: a report of 83 cases[J].Journal of Clinical Pediatric Surgery,2020,19(06):432.[doi:10.3969/j.issn.1671-6353.2020.05.011]
[8]马立飞,周辉霞,周晓光,等.吲哚菁绿荧光实时显影技术在儿童复杂肾积水机器人辅助腹腔镜手术中的初步应用[J].临床小儿外科杂志,2021,20(10):921.[doi:10.12260/lcxewkzz.2021.10.005]
Ma Lifei,Zhou Huixia,Zhou Xiaoguang,et al.Applications of indocyanine green and near-infrared fluorescence during complex robot-assisted laparoscopic pyeloplasty[J].Journal of Clinical Pediatric Surgery,2021,20(06):921.[doi:10.12260/lcxewkzz.2021.10.005]
[9]何雨竹,李佳义,宋宏程,等.腹腔镜及开放手术治疗儿童先天性肾盂输尿管连接处梗阻性肾积水的并发症对比[J].临床小儿外科杂志,2024,(04):315.[doi:10.3760/cma.j.cn101785-202403060-004]
He Yuzhu,Li Jiayi,Song Hongcheng,et al.Comparative analysis of complications between open and laparoscopic pyeloplasty for congenital ureteropelvic junction obstructive hydronephrosis in children[J].Journal of Clinical Pediatric Surgery,2024,(06):315.[doi:10.3760/cma.j.cn101785-202403060-004]
[10]李静涛,郎兴,魏建新,等.血清LRG1、NGAL和PGC-1α水平与小儿肾积水手术后分肾功能的相关性研究[J].临床小儿外科杂志,2024,(04):335.[doi:10.3760/cma.j.cn101785-202403060-007]
Li Jingtao,Lang Xing,Wei Jianxin,et al.Correlation between serum leucine rich alpha-2-glycoprotein 1,neutrophil gelatinase associated apolipoprotein,peroxisome proliferator activated receptor γ coactivator factor-1α and postoperative renal function in children with hydronephrosis[J].Journal of Clinical Pediatric Surgery,2024,(06):335.[doi:10.3760/cma.j.cn101785-202403060-007]