重复肾输尿管畸形伴下位肾重度积水一例报告

重复肾输尿管畸形是常见的泌尿系畸形之一,多数患者无明显临床表现,极少部分病例合并输尿管梗阻,导致肾积水呈囊状结构,临床上易与单纯性肾囊肿相混淆。本文报道1例右侧重复肾输尿管畸形伴下位肾巨大肾积水患者,旨在为临床诊治提供参考。     

重复肾合并肾癌肾积水1例报告并文献复习

目的探讨重复肾合并肾癌肾积水的诊断和治疗,提高罕见病例的诊疗水平。方法回顾我院收治的1例重复肾合并肾癌肾积水患者的临床资料,结合文献讨论该病的临床特点以及诊断、治疗方法。结果患者明确诊断后行经腹左肾癌根治术,术后病理提示透明细胞癌伴淋巴结转移,给予辅助靶向治疗,随访6个月未见肿瘤复发及转移。结论重复肾合并肾癌肾积水临床上较为罕见,且影像学诊断容易误诊,CT尿路成像技术(CTU)应该成为诊断的首选。手术是首要治疗方法,一般认为早期确诊及治疗对疾病的预后有较大作用。     

重复肾、重复输尿管闭锁并巨大输尿管积水1例

1 病例报告 患者，男，40岁，以体检时发现右肾囊肿1年6个月入院。查体：右肾区隆起，无叩击痛，腰椎稍向右侧弯曲。超声检查：左肾、左输尿管未见异常；右肾集合系统可见3.5cm×1.7cm的不规则无回声区，其下缘似可见一小段输尿管样影像，另可见一缘起自右肾上部，下缘达膀胱后方的不规则无回声区，     

成人重复肾畸形并肾积水的诊疗分析

目的分析总结成人重复肾畸形并肾积水的诊疗方案。方法回顾性分析40例成人重复肾畸形并肾积水患者的临床资料,其中男性11例,女性29例,年龄18～77岁。并发重度肾积水29例,轻度肾积水11例。结果 29例重度肾积水患者均行肾部分切除术,其中开放手术23例,腹腔镜手术6例;11例轻度肾积水患者中5例行输尿管膀胱再植术,5例行输尿管囊肿电切术,1例行肾盂成形术。40例患者中3例出现术后并发症。结论成人重复肾畸形并重度肾积水者应行肾部分切除术,腹腔镜较之开放手术具有创伤小、出血少、恢复快等优点;轻度肾积水者可通过解除膀胱输尿管返流、输尿管口囊肿、肾盂输尿管连接部梗阻等改善肾功能。     

肾结石并肾胶冻状积水1例

患者 ,男 ,5 9岁。因右肾区胀痛 1年 ,排尿疼痛、尿流中断、血尿 5个月于 2 0 0 1年 7月 3日入院。 1年前 B超检查发现右肾结石 1 .5 cm× 1 .2 cm× 1 .0cm,5个月前再次 B超检查示右肾多发性结石 ,右肾积液 ,右输尿管上段结石 ,膀胱多发性结石。体检 :T 36.8℃ ,P 72次 /min,BP 1 2 8/78mm Hg( 1mm Hg=0 .1 33k Pa) ,脊柱生理弯曲正常 ,甲状腺无结节 ,右肾肋下 5 cm可扪及 ,无压痛。尿常规RBC( + + ) ,WBC( + )。血常规、肝功能、血糖均正常。血钾 4.5 mmol/L,血钠 1 47mmol/L ,血钙 2 .0mmol/L,血氯 1 1 4mmol/L ,尿素氮 4.6mmol/…     

肾裁剪治疗肾结石并重度积水

16例肾结石并重度肾积水，行肾盂肾皮质切开取石后，行肾裁剪法成形。术后疗效满意，引流通畅，未出现感染加重、出血、漏尿等并发症。肾裁剪法治疗肾结石并重度肾积水疗效好，简单、安全、肾功能恢复快。     

重复肾17例临床分析

目的 提高重复肾的诊治水平。方法 对我院1993年5月至2001年6月收治的17例重复肾临床资料进行回顾性分析。结果 术前明确诊断12例,术中发现5例,术前误诊3例。手术治疗15例。结论 重复肾本身无特殊临床症状,多因其并发症经B超、IVU、膀胱镜检查、逆行肾盂造影等检查可诊断。重复肾在无并发症或积水时,可不必处理。若有并发症存在,需外科治疗。     

重复肾下肾积水(附24例报告)

目的：为探讨重复肾下肾积水的原因，治疗方法及预后。方法：总结30年来收治重复肾下肾积水患者24例，平均33．4岁，行迷走血管及纤维束带松解，输尿管膀胱成形术等手术治疗。结果：手术发现有9例为管外因素压迫及吊勒（37．5％），输尿管反流14例（58．3％），输尿管结石1例（4．2％），结论：对于重复肾下肾积水的原因诊断中一定要重视管外因素的作用，在治疗原则上，因其常伴有上肾的积水，肾功能亦受到损害，故切不可轻易切除下肾，而宜行解除梗阻或成形手术。     

盆腔脂肪增多症合并左侧重复肾畸形1例诊治报告并文献复习

目的:提高盆腔脂肪增多症(PL)的诊断及治疗水平。方法:对1例PL合并左侧重复肾畸形的临床诊治过程进行回顾性分析,并结合相关文献对PL的诊断及治疗进行探讨。结果:患者于治疗6个月后体重减轻10kg,尿路刺激症状较治疗前明显好转,肌酐正常范围内,左侧腰背部无明显酸胀不适,第1、3、6个月门诊复查,泌尿B超示左下肾仍有积水但随体重的降低积水程度逐渐减轻。结论:X线、CT及MRI为此病的主要诊断线索及依据,但治疗上尚无统一规范化指南,尚需更多的前瞻性随机对照研究和多中心大宗病例规范治疗方案。     

完全性重复肾输尿管并重度积水1例

<正>1病历摘要患者,男,34岁,因"发现腹腔内巨大囊性占位4天"入院。患者4天前因腹痛于当地医院就诊,行CT检查示左侧肾盂旁巨大囊肿并腹腔积液。追问患者病史,否认平素肾区胀痛感,否认高血压,否认肉眼血尿,否认发热等不适。否认外伤史,否认遗传病史。入院后专科查体:腹膨隆,腹部可触及一巨大囊性占位,无压痛及反跳痛,双肾区无叩痛,左肾区叩击伴明显液波震颤感,双侧输     

重肾双输尿管并发上位肾积水3例误诊分析

目的：分析重肾双输尿管并发上位肾积水误诊原因，探讨临床不典型囊肿、肾上腺囊肿的诊断方法。方法：回顾性分析３例重肾双输尿管并发上位肾积水误诊的临床资料。结果：左侧２例、右侧１例。均行手术治疗，术中发现为重肾双输尿管上位肾积水，解除梗阴因素并行整形，术后半年随访，无复发。结论：诊断肾囊肿、肾上腺囊肿时应考虑本病并进行相应检查；对于肾囊肿、肾上腺囊肿穿刺注射无水乙醇应慎重。     

Assessment of regional kidney function may provide new clinical understanding and assist in treatment of children with prenatal hydronephrosis

PURPOSE: As calculated from a (99m)technetium (Tc)-mercaptoacetyltriglycine (MAG3) renogram, differential renal function is an important parameter affecting the clinical treatment of children with prenatal unilateral hydronephrosis. We determined whether value is potentially added by calculating a functional image from MAG3 renograms that represents proximal tubule ability to clear tracer from the blood, that is the MAG3 clearance image. MATERIALS AND METHODS: MAG3 clearance image findings and differential renal function at presentation and followup in 59 nonsurgically and 42 surgically treated children with prenatally diagnosed unilateral hydronephrosis were retrospectively reviewed. All patients underwent at least 3 99mTc-MAG3 renograms. RESULTS: In the surgical and nonsurgical groups there was no significant difference in followup (p = 0.11), age at presentation (p = 0.98) or age at last visit (p = 0.97), whereas differential renal function was significantly different (p = 0.01). A large affected kidney with focal defects was the most frequent finding in each group, including kidneys with a normal differential renal function of 45% to 55%. In the nonsurgical group the most common observation was improvement in the MAG3 clearance image in 26 of 59 cases (44%) and stabilized differential renal function in 41 (70%). Postoperatively the MAG3 clearance image improved in 31 of 42 cases (74%) and differential renal function remained stable in 25 (60%), while no significant increase in differential renal function was noted at the last visit (p = 0.74). CONCLUSIONS: This study shows that it is possible to assess regional parenchymal function using the MAG3 clearance image in children with unilateral hydronephrosis. This information is available in addition to 99mTc-MAG3 information on the whole kidney, that is differential renal function. The majority of affected kidneys with normal differential renal function showed parenchymal defects, suggesting regional renal dysfunction. However, functional improvement on a regional basis occurred in each group of children during followup.     

后腹腔镜术切除无功能积水肾的疗效观察

目的：探讨后腹腔镜下切除无功能积水肾的可行性和安全性及规避手术风险的方法。方法：对62例积水无功能肾患者行后腹腔镜积水无功能肾切除术。术前常规行肾脏CT平扫及增强检奄。利用PACS系统仔细阅片,了解肾动脉分支及走向。然后建立腹膜后腔隙,参照解剖标志充分显露。肾蒂血管,用Hem-o—lok夹闭肾蒂血管后切断,分离切除患肾,留置腹膜后引流管,并统计手术时间、术中m血量和术中术后并发症,观察手术效果。结果：62例患者手术均获得成功,手术时间为50～180min,平均为130min。术中出血10～100m1．平均37ml。术中损伤腹膜3例,胸膜1例,未发现血管损伤、腹腔脏器损伤等并发症。引流管于术后2～3天拔除,术后住院5～10天,平均6．5天。结论：后腹腔镜下积水无功能肾切除术安全可行,术中通过辨认解剖标志结扎肾蒂血管和沿正确的平面游离患肾是手术成功的关键。     

后腹腔镜切除积水无功能肾17例

目的探讨后腹腔镜积水无功能肾切除术的手术方法和效果。方法对17例积水无功能肾患者行后腹腔镜积水无功能肾切除术。腰部3个Trocar穿刺入路,手指法建立后腹膜气腹,游离出部分病变肾脏后先将肾脏切开一小口,吸净积水肾内的积水,然后再游离肾脏,用钛夹或Hem-o-lok夹闭肾蒂血管后切断,切除患肾,留置腹膜后引流管。统计手术时间、术中出血量和术中、术后并发症及观察手术效果。结果17例手术均获得成功,手术时间为150．300min,平均为170min。术中出血10-80ml,平均30ml。引流管于术后2-3d拔除,无大出血、感染、腹膜破裂、腹腔脏器损伤等并发症。结论后腹腔镜积水无功能肾切除术是一种微创、安全、有效、恢复快的术式。     

Congenital unilateral hydronephrosis: a review of the impact of diuretic renography on clinical treatment

PURPOSE: The natural history of and optimal treatment for asymptomatic congenital hydronephrosis is unknown, mainly because most published series are nonrandomized or retrospective with nonstandardized followup regimens. In this survey we provide an overview of the different strategies used for the treatment of congenital unilateral hydronephrosis. MATERIALS AND METHODS: A comprehensive literature review of clinical studies of asymptomatic congenital unilateral hydronephrosis is presented. RESULTS: Different criteria for surgical intervention and different followup regimens have been used. Identification of the population at risk has been attempted but results are ambiguous. Surgery is done in approximately 25% of cases when using deteriorating differential function, symptoms and/or increasing hydronephrosis as criteria for operation. A nonstandardized renographic assessment does not compromise evaluation of the ideal followup but it may compromise the functional outcome. CONCLUSIONS: More studies of kidneys with decreased function, severe hydronephrosis or poor drainage investigated with a standardized protocol are needed to clarify the natural history and establish optimal guidelines for treatment and followup.     

Laparoscopic nephrectomy for a girl with giant hydronephrosis of a horseshoe kidney

We report our experience of laparoscopic nephrectomy on a girl with giant hydronephrosis of a horseshoe kidney. An 8-year-old girl presented with a 4-month history of right abdominal pain. We performed laparoscopic nephrectomy for the non-functioning moiety of a horseshoe kidney secondary to uretero-pelvic junction obstruction. Laparoscopic nephrectomy is a feasible and safe method with good indications especially for children with a horseshoe kidney disease.     

左侧多发性肾上腺囊肿并左侧重复肾双输尿管畸形1例

目的探讨多发性肾上腺囊肿合并重复肾双输尿管畸形的诊断、鉴别诊断和治疗。方藩回顾分析1例左侧多发性肾上腺囊肿并左侧重复肾双输尿管畸形的临床资料。并结合文献进行讨论。结果术前联合应用B超、CT检查，诊断为左肾上腺多发囊肿；行IVU检查。进一步发现了重复肾双输尿管畸形，避免了漏诊和误诊。行后腹腔镜肾上腺囊肿探查术。术中见左肾上腺有2个囊肿。因术前CT及术中均可见囊壁钙化，术中行冰冻病理检查诊断为假性囊肿，行囊肿切除术。随访18个月未见复发，结论治疗方法取决于囊肿大小、重复肾的功能、是否有并发症等。对囊壁有钙化者，术中应行冰冻病理检查以确定有无恶性病变。后腹腔镜肾上腺囊肿切除术是外科首选的治疗方法。     

Long-term followup of prenatally detected severe bilateral newborn hydronephrosis initially managed nonoperatively

PURPOSE: We determine the outcome of severe bilateral primary ureteropelvic junction type hydronephrosis detected prenatally and managed postnatally with an initially nonoperative protocol. MATERIALS AND METHODS: A total of 19 newborns (38 kidneys) with prenatally diagnosed primary grade 3 to 4 bilateral hydronephrosis were followed nonoperatively for a mean of 54 months (range 14 to 187). If urinary obstruction with evidence of renal deterioration (decreased differential function and/or progressive hydronephrosis) occurred pyeloplasty was performed. RESULTS: Pyeloplasty was required in 13 kidneys (35%) in 9 patients (bilateral 4, unilateral 5). Age at pyeloplasty ranged from 2 to 22 months (mean 6.5) in 12 patients and 64 months in 1. The remaining 25 kidneys were followed nonoperatively (bilateral 20, unilateral 5). At last followup the Society for Fetal Urology grade of hydronephrosis in kidneys followed nonoperatively was 0 to 2 in 21 and 3 in 4, compared to 0 to 2 in 9 and Society for Fetal Urology 3 in 4 kidneys treated with pyeloplasty. Mean followup required for the most severely hydronephrotic kidney to achieve maximum ultrasound improvement was 10 months (range 3 to 34) for kidneys followed nonoperatively and 14 months (4-31) for kidneys after pyeloplasty. Differential renal function was measured in each kidney pair and compared using the difference in percent function between the 2 kidneys. In the nonoperative group mean initial difference in percent function was 8% (range 6% to 20%) and mean final difference was 5% (2% to 8%). In the pyeloplasty group mean initial difference in percent function was 16% (range 8% to 30%) and mean final difference was 7% (2% to 16%). With close followup and prompt pyeloplasty renal function improved to greater than pre-deterioration levels in all kidneys. CONCLUSIONS: These data represent the natural history of severe bilateral newborn hydronephrosis. Renal dilatation and function improve with time in most kidneys. Close followup is required in the first 2 years of life to identify the subgroup (35%) of children with obstruction that requires prompt surgery. Such an approach prevented permanent loss of renal function. Nonoperative management with close followup during the first 2 years appears to be a safe and recommended approach for neonates with primary bilateral ureteropelvic junction type hydronephrosis.