巨输尿管症22例诊治报告并文献复习

目的探讨巨输尿管症的治疗方法。方法回顾性分析22例巨输尿管症患者的临床资料,其中男16例,女6例;左侧12例,右侧6例,双侧4例。结果 12例行输尿管整形后膀胱再植术,6例行输尿管支架管植入术,4例行患侧无功能肾切除术。随访1~6年,12例再植术后肾功能均正常,10例肾积水明显减轻,吻合口无狭窄及膀胱输尿管无返流,2例术后输尿管及肾脏积水无改善,长期观察肾积水无加重且无临床症状,未进一步治疗;6例行支架管置入术后积水可减轻,拔出支架管后5例肾积水程度无变化,1例渐加重,伴发热,给予行肾脏穿刺引流后行输尿管膀胱再植术,术后肾积水明显减轻;4例肾切除术后对侧肾脏功能正常。结论 IVU检查诊断梗阻型巨输尿管症显影率低,MRU具有较好的应用前景;巨输尿管症治疗原则是解除梗阻,保持输尿管通畅并防止返流及狭窄;最佳手术治疗方法是进行输尿管整形(裁剪或折叠)后膀胱再植术,保守治疗也可作为治疗的选择之一。

Diagnosis and treatment of megaureter （a report of 22 cases and literature review）

Objective To investigate the treatment for megaureter. Methods Data of 22 adult patients with megaureter were retrospectively analyzed, including 16 males and 6 females. 12 cases were on the left side while 6 on the right, and 4 cases were bilateral. Results Altogether 12 cases were treated with ureter tailoring and ureterovesical reimplantation, 6 cases re- ceived douhle-J stent, and 4 cases underwent nephrectomy and total ureterectomy. During the follow-up of 1 ~ 6 years, kidney function restored in the 12 cases who underwent ureterovesical reimplantation, and 10 cases had hydronephrosis significantly relieved without narrow anastomotic site and reflux between bladder and ureter, and 2 cases remained unimproved. The hydro- nephrosis relieved in the 6 cases who had double-J stent. When the double-J stent was removed, hydronephrosis had no change in 5 cases; 1 case turned worse and then ureterovesical reimplantation was performed. The contralateral kidney function re- stored in the 4 cases after nephrectomy. Conclusions IVU is not effective for obstructive megaureters, while MRU will play an important role in the future. Eliminating the obstruction is the principle of treatment for megaureter. To maintain the ure- teral unobstructed and prevent reflux and stricture, ureter tailoring and ureterovesical reimplantation are the first choice. Con- servative treatment can also be an alternative in the management of megaureter.