新生儿重度肾积水的手术治疗及疗效观察

目的 探讨重度肾积水新生儿期手术干预的可行性和疗效.方法 回顾性分析了新生儿期接受手术治疗的18例重度肾积水患儿的临床资料.结果 16例于新生儿期行离断式肾盂输尿管成形术(Anderso-Hynes术),2例Ⅰ期行肾造瘘术,Ⅱ期行肾盂成形术,所有病例术中麻醉及手术过程顺利,术后恢复满意.术后除1例有轻度切口疝外,无术后出血、感染、吻合口瘘和吻合口狭窄等并发症.术后随访1.3年(3个月～4年),患儿生长发育正常,无尿路感染症状,患肾积水明显减轻、甚至消失,肾实质厚度增加,肾脏形态接近正常.结论 新生儿期手术干预能早期解除肾内压力,不仅能尽快恢复患肾功能,而且患肾形态有望恢复正常.产前诊断重度胎儿肾积水的患儿于生后1～2周应常规行B超检查,同时结合CTU或MRU加SPECT检查以明确诊断.确诊存在器质性梗阻的新生儿,若为重度肾积水,分肾功能<35%或伴发严重泌尿系感染者,建议尽早手术干预.

Operative management and therapeutic effects of severe neonatal hydronephrosis

Objective To present the strategy and efficacy for .severe neonatal hydronephrosis.Methods Eighteen neonates with severe hydronephrosis who underwent surgical treatments were recruited in this study.Results Sixteen patients underwent single stage Anderso-Hynes dismembered pyeloplasty.The other two patients underwent nephrostomy at the first stage, and pyeloplasty at the second stage two months later.All patients recovered from surgery without any complications except one had mild incision hernia.The patients have been followed up for an average period of 1.3 years (range, 3 montha to 4 years).No postoperative bleeding, infection, anastomotic leakage or stenosis was noted during follow-up.The hydronephrosis of the affected kidneys was significantly alleviated or even disappeared after surgery.The thickness of renal parenchyma increased, and the kidneys appcared almost normal Conclusions The function and morphology of the neonatal hydronephrotic kidneys restore quickly after relieving intrarenal pressure of the affected kidrays by surgery.The kidneys of the neonates diagnosed with severe prenatal hydronephrosis should be routinely examined by uhrasonography combining CTU , MRU or SPECT in 1-2 weeks after birth.If organic tmeteropelvic junction ohatruction is confirmed, and split function of hydronephrotic kidneys less than 35% or with severe urinary tract infection, early surgical intervention should be carried out to preserve renal functions.