Lu Qiang,Ma Hong,Dong Shuquan,et al.Evaluation of clinical diagnosis and treatment of renal duplication in 56 children[J].Journal of Clinical Pediatric Surgery,2019,18(05):424-428.[doi:10.3969/j.issn.1671-6353.2019.05.017]
56例小儿重复肾临床诊疗分析
- Title:
- Evaluation of clinical diagnosis and treatment of renal duplication in 56 children
- Keywords:
- Kidey/AB; Kidey/SU; Diagnosis; Urologic Surgical Procedures; Treatment Outcome
- 分类号:
- R726.9;R692.1+1
- 摘要:
- 目的 探讨小儿重复肾的诊断与治疗方法，以进一步规范其诊疗流程。方法 对遵义医学院附属医院10余年收治的小儿重复肾畸形56例的临床资料进行回顾性分析。对其临床表现、分型、诊断及治疗方法进行总结分析。结果 56例中重复肾重复输尿管无积水且IVU显影正常者11例，保守随访观察。重复肾发育不良、重复肾积水伴重复输尿管积水并输尿管异位开口、IVU不显影和SPECT检测GFR（肾小球滤过率）无功能35例，予以重复肾重复输尿管探查切除。重复肾功能尚存、重复输尿管扩张（直径大于4.0 cm）、积水3例，予以重复肾与下位肾肾盂吻合成形术治疗；重复肾功能尚存、重复输尿管扩张（直径小于4.0 cm）、积水伴输尿管末端囊肿5例（不伴膀胱输尿管反流），予以输尿管末端囊肿戳穿术治疗；不伴输尿管末端囊肿2例，予以重复输尿管膀胱再植术治疗。术后随访6个月至7年，除1例因合并骶脊膜膨出术致神经源性膀胱表现为尿失禁外，其余术前存在泌尿系感染的病例感染症状均消失。术前不存在泌尿系感染的病例术后亦未出现泌尿系新发感染，行输尿管囊肿戳破术及膀胱输尿管再植的病例术后未出现膀胱输尿管反流。结论 小儿重复肾畸形临床表现多样，B超、IVU、SPECT、VCUG及泌尿系MRU检查是诊断的主要方法，膀胱镜输尿管插管逆行造影有一定的补充性诊断价值。治疗则应依据重复肾功能、重复肾重复输尿管有无积水以及是否合并重复输尿管异位开口，采用个体化治疗方案。
- Abstract:
- Objective To investigate furtherly clinical standard diagnosis and treatment of renal duplication in children.Methods The clinical data of 56 cases of childrens,renal duplication were retrospectively analyzed in our hospital in the past more than 10 years. Their clinical manifestation,classification,diagnosis and treatment were summarized and analyzedResults Among of them,11 cases of renal duplication without hydronephrosis and normal IVU imaging were observed following-up.To resect renal duplication and its,ureter in 35 cases with non-function renal duplication by no IVU imaging and SPECT detecting GFR(glomerular filtration rate).The 3 cases of renal duplication with ureteral duplication dilatation (Diameter larger than 4.0 cm) have done anastomosis between duplex kidney and lower renal pelvis.And another 5 cases of renal duplication with ureteral duplication dilatation (less than 4.0 cm in diameter) with end-stage cyst of ureter (without vesicoureteral reflux) have done ureteral cyst puncture and 2 cases without end-stage cyst of ureter have done the replantation between ureteral duplication and bladder.All patients were followed up from 6 months to 7 years with average following-up 5 years.The clinical symptoms of result cases have disappeared after operation except for 1 patient with urinary incontinence due to the operration of sacro-meningocele with neurogenic bladder.After the cases of having done ureteral cyst puncture or the replantation between ureteral duplication and bladder don’t have vesicoureteral reflux.Conclusion To be present all sort of clinical manifestations of renal duplication in children.It is a helpful to diagnosis renal duplication by B-ultrasound、IVU、SPECT and urinary MRU、VCUG and Retrograde pyelography.Individual Treatment of renal duplication should be executived on based function of renal duplication and ureteral ectopic openingl.
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相似文献/References:
[1]周晓光 周辉霞 马立飞 谢华伟. 经脐单孔腹腔镜实施小儿重复肾半肾切除术[J].临床小儿外科杂志,2012,11(05):357.
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备注/Memo
收稿日期:2018-10-01。
基金项目:贵州省卫生与计划生育委员会项目（gzljk2013-1-004）
通讯作者:马洪,Email:mahong9195@163.com