成人肾盂输尿管连接部梗阻的手术治疗

目的 总结成人肾盂输尿管连接部梗阻的诊治经验。方法 对我院1990年7月至2003年6月收治的56例成人肾盂输尿管连接部梗阻患者的病因、诊断及治疗结果进行回顾性分析。结果 肾盂输尿管连接部狭窄引起梗阻者46例(82．1％)，其中3例为双侧；粘连带压迫者3例(5．3％)，输尿管肾盂高位连接者4例次(7．3％)，异位血管压迫者3例次(5．3％)。共行手术59例次，Anderson—Hynes离断式肾盂成形术47例次，肾盂Y—V成形术4例，纤维条索松解3例，异位血管切断3例，肾切除术2例。本组病例除2例肾切除者外，余54例均于术后3个月至1年进行复查随访，50例痊愈。总治愈率92．8％。4例(7．2％)发生再狭窄，二次行肾盂成形术后均痊愈。结论 IVU和RU是诊断成人肾盂输尿管连接部梗阻的主要方法，Anderson-Hynes离断式肾盂成形术是治疗成人肾盂输尿管连接部梗阻的首选术式。

Operative treatment of ureteropelvic junction obstruction in adults

Objective To summarize the experience in the treatment of ureteropelvic junction obstruction in adults. Methods The clinical data including etiology, diagnosis, and outcomes of surgery from 56 adult patients with ureteropelvic junction obstruction admitted to our hospital from 1990 to 2003 were analyzed retrospectively. Results Etiological factors included ureteropelvic junction stricture in 46 cases (82.1%, bilateral in 3 cases), fiber chords in 3 cases (5.3%), high location of the junction in 4 cases (7.3%), and ectopic vessels in 3 cases (5.3%). A total of 59 cases-times of surgical procedures were performed, including 47 cases-times of Anderson-Hynes pelvioplasty, 4 cases-times of Y-V pyeloplasty, 3 cases-times of chord brisement, 3 cases-times of ectopic vessel resection, and 2 cases-times of nephrectomy. After a follow-up of 54 patients for 3 months to 12 months, complete recovery was found in 50 patients with a cure rate of 92.8%, and 4 patients underwent Anderson-Hynes pelvioplasty again due to stricture recurrence. All the patients with recurrence were completely cured. Conclusion Intravenous urography (IVU) and retrograde ureteropyelography (RU) are the two main methods for the diagnosis of ureteropelvic junction obstruction in adults. Anderson-Hynes pelvioplasty is the first choice for the treatment of ureteropelvic junction obstruction in adults.