Wang Xinyu,Zhao Yongxiang,Song Hongcheng,et al.Diagnoses and surgical managements of pediatric calyceal diverticulum[J].Journal of Clinical Pediatric Surgery,2023,22(04):367-372.[doi:10.3760/cma.j.cn101785-202204004-013]
儿童肾盏憩室诊治分析
- Title:
- Diagnoses and surgical managements of pediatric calyceal diverticulum
- Keywords:
- Calyceal Diverticulum; Kidney Diseases; Ultrasonography; Urologic Surgical Procedures; Child
- 摘要:
- 目的 探讨儿童肾盏憩室(calyceal diverticulum,CD)的临床特点、诊断及手术治疗方式。方法 回顾性分析2010年1月至2021年10月首都医科大学附属北京儿童医院泌尿外科与包头市第四医院小儿外科收治的7例肾盏憩室患儿临床资料,其中男5例,女2例;就诊年龄8个月至11岁,平均年龄3岁11个月。憩室位于左侧3例,右侧4例;肾上盏4例,肾中盏3例。憩室长径3~9 cm,平均6.2 cm。产前超声发现肾脏囊性变3例,腹痛2例,无症状腹部包块1例,体检发现肾脏囊性病变合并高血压1例。3例术前经泌尿系超声检查确诊,4例术中确诊。7例均行手术治疗,其中开放肾盏憩室切除术2例,肾盏憩室剪裁+盏颈扩大术3例,开放和腹腔镜憩室壁翻瓣卷管输尿管端侧吻合术各1例。结果 7例均获随访,随访时间3个月至10年,患儿术后CD相关症状均消失,术前扩张的肾盏憩室均明显缩小,无一例复发;1例合并肾积水患儿术后积水明显减轻,但肾功能恢复较差,肾核素扫描显示分肾功能为20%,目前仍在随访中。结论 肾盏憩室易发生反复泌尿系感染、慢性腹痛、肉眼血尿、结石等,易误诊为单纯性肾囊肿,两者处理方式不同,需加以区分。应根据憩室位置、盏颈狭窄程度采取个体化治疗,包括肾盏憩室切除、盏颈扩大部分憩室切除、憩室壁翻瓣卷管输尿管端侧吻合术。如处理得当通常预后较好,少有复发。
- Abstract:
- Objective To explore the clinical features,diagnosis and treatment of calyceal diverticulum(CD)in children.Methods From January 2010 to October 2021,clinical data were retrospectively reviewed for of 7 CD children.There were 5 boys and 2 girls with a mean age of 47(8-132)months.The average diverticulum size was 6.2(3-9)cm.And the involved side was left(n=3)and right(n=4).The site was upper calyx(n=3)and middle calyx(n=2).The presenting manifestations were renal cystic lesion on prenatal ultrasound(n=3),abdominal pain(n=2),asymptomatic abdominal mass(n=1)and renal cystic lesion with hypertension found incidentally(n=1).The lesion were confirmed by preoperative urinary ultrasound(n=3)and detected intraoperatively(n=4).The surgical procedures included open diverticulectomy(n=2),enlargement of communication after clipping diverticulum(n=3)and tubularized turn-over flap ureteral end-to-side anastomosis(n=2,laparotomy and laparoscopy each).Results During a follow-up period of(3-120)months,the symptoms disappeared and there was no dilated diverticulum or recurrence.One case of ureteropelvic junction obstruction had a marked relief.Renal function remained poor at 20% and was still monitored.Conclusion Pediatric calyceal diverticulum has a low incidence.Recurrent urinary infections,chronic abdominal pain,hematuria and stones due to urinary retention in diverticulum occur approximately in 1/3-1/2 of patients.It is easy to misdiagnose it as a simple renal cyst by ultrasound.However,treatments are totally different and two conditions should be distinguished carefully.Individualized treatments should be adopted depending upon the site and severity of communication,including open diverticulectomy,enlargement of communication after clipping diverticulum and tubularized turn-over flap ureteral end-to-side anastomosis.Prognosis is generally decent.
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备注/Memo
收稿日期:2022-4-2。
通讯作者:宋宏程,Email:songhch1975@126.com