迷走血管压迫致梗阻性肾积水34例临床分析

目的探讨小儿肾盂输尿管交界部迷走血管压迫致梗阻性肾积水的临床特点及治疗方法。方法回顾性分析1997年1月至2008年6月本院收治的34例迷走血管压迫性肾积水患儿的临床资料。结果34例中,男30例,女4例,左侧28例,右侧6例。平均发病年龄9．5岁。手术方法为离断性肾盂成型术（Anderson—Hynes术式）,术中同时将迷走血管移向肾盂后方。病理检查证实12例合并肾盂输尿管交界部狭窄,术后半年行IVP复查,积水缓解,症状消失。结论小儿肾盂输尿管交界部迷走血管压迫致梗阻性肾积水发病年龄较大,腹痛明显,积水较轻。治疗上在采取离断性肾盂成刮术的同时,应将迷走血管转移到肾盂输尿管交接部的后方。马蹄肾合并肾积水时迷走血管压迫是主要的发病原因。     

重肾双输尿管合并下肾肾盂输尿管连接部梗阻性肾积水的诊疗分析

目的 探讨小儿重肾双输尿管合并下肾肾盂输尿管连接部梗阻性肾积水的临床特点及诊疗方法.方法 回顾性分析本院近10年来收治的190例重肾双输尿管畸形病例中,6例合并下肾肾盂输尿管连接部梗阻性肾积水患儿的临床资料,包括年龄、性别、临床症状、解剖结构及处理方法等.结果 重肾双输尿管畸形患儿190例,合并下肾肾盂输尿管连接部梗阻性肾积水6例,占3.16%.其中男5例,女1例,年龄10 d至3岁7个月,平均13.8个月.围产期行B超检查发现肾积水4例,泌尿系感染1例,腹部包块1例.病变位于左侧3例,右侧3例;3例为重肾完全型双输尿管,3例为重肾Y型输尿管,其中1例为右重肾Y型输尿管合并下肾肾盂输尿管连接部狭窄及下肾输尿管膀胱连接部狭窄.3例重肾完全型双输尿管病例中,1例行上组肾及输尿管切除＋下组肾离断性肾盂成形术,2例行下组肾离断性肾盂成形术;3例重肾Y型输尿管中,2例行上肾输尿管下肾盂端侧吻合＋下组肾离断性肾盂成形术,1例行上组肾及输尿管切除＋下组肾离断性肾盂成形术＋输尿管膀胱再植术.术后随访3~18个月,平均12个月,B超及IVP显示肾积水明显好转,无并发症.结论 重肾双输尿管合并下肾肾盂输尿管连接部梗阻性肾积水发病率低,易误诊.术前B超、IVP及MRU是有效的辅助检查手段.临床应根据患儿肾功能及解剖异常情况制定个体化的手术方案.     

小儿输尿管息肉3例治疗体会

小儿输尿管息肉又称输尿管纤维息肉或上皮息肉,系输尿管原发良性病变,多发生在输尿管上段及肾盂输尿管连接处。其主要病理结果为肾积水,现总结3例输尿管息肉引起梗阻性肾积水患儿的临床特点及诊治经过。     

S100、Cajal间质细胞在先天性肾盂输尿管连接处梗阻的表达

先天性肾积水是儿童常见疾病,其原因较多,其中90%为肾盂输尿管连接处梗阻。引起肾盂输尿管连接处梗阻的病因和病理机制尚未完全阐明,国内外有较多的观点。最近国外研究发现肾盂输尿管连接处狭窄段肌层神经纤维缺乏     

先天性肾盂输尿管连接处梗阻的诊断和治疗

目的 探讨先天性肾盂输尿管连接处梗阻(UPJO)致肾积水的诊断和治疗方法.方法 回顾分析UPJO致肾积水患儿63例的临床资料.患儿均经彩超筛查、静脉肾盂造影(IVP)、磁共振尿路成像(MRU)或电子计算机X射线断层扫描尿路成像(CTU)确诊.单侧肾积水55例中47例行一期离断式肾盂输尿管成形术,切除无蠕动功能的肾盂输尿管狭窄段和大部分扩张的肾盂;5例因重度肾积水先行患肾穿刺造瘘引流3～6个月,其中3例二期行离断性肾盂成形术,另2例因肾脏无功能行肾切除术;3例保守治疗.双侧肾积水8例中3例一期完成双侧肾盂输尿管成形术,5例分次完成.结果 术后B超随访,肾积水均有改善,肾盂前后径缩小,肾实质增厚;IVP均证实肾盂输尿管吻合口通畅.肾脏积水导致肾功能受损者,术后肾动态显像榆查患肾功能均有恢复.结论 彩超为UPJO诊断最常用的筛查方法,IVU、MRU及CTU是确诊UPJO的可靠方法,先天性肾盂输尿管连接部狭窄是造成肾积水的首要原因、肾盂进行性扩张或肾功能损害进行性加重者需行离断性肾盂成形术.     

小儿输尿管息肉诊治13例

目的 探讨小儿输尿管息肉所致梗阻性肾积水的临床特点以及诊断和治疗方法.方法 回顾性分析本院1996年至2006年收治的13例输尿管息肉所致梗阻性肾积水患儿的临床资料.其中男11例,女2例;年龄6～14岁,平均年龄8.4岁;左侧12例,右侧1例;10例表现为剧烈间歇件腹痛,伴血尿、呕吐,1例为单纯件血尿,2例于体检时发现;所有患儿均行B超、大剂量静脉肾盂造影(IVP)、动态性同位素(DTPA)检查,结果均提示中至重度肾积水,梗阻位于肾盂输尿管交界处或输尿管上段部位.均切除病变段输尿管、行输尿管肾盂吻合或输尿管端端吻合术.结果手术及术后病理检企均提示为输尿管息肉造成的梗阻性肾积水,术后随访12例恢复正常,1例因术前患肾功能较差,术后持续肾功能下降而行患肾切除.结论输尿管息肉致梗阻性肾积水为良性病变.临床表现为患肾区较剧烈的疼痛,大剂量静脉肾盂造影(IVP)可见充盈缺损.积水严重者应手术治疗,以离断法肾盂成形术为主,包括息肉段输尿管切断加肾盂输尿管吻合术或息肉段输尿管切断加输尿管端端吻合术.     

小儿先天性肾盂输尿管连接处梗阻的微创治疗研究进展

小儿先天性肾积水主要是由先天性。肾盂输尿管连接处梗阻（ureteropelvic junction obstrction，UPJO）引起，发病率报道不一，一般为0．13％-0．16％，目前公认最合理的手术方法是离断式肾盂输尿管成形术（Anderson—Hynes术），此术式裁剪肾盂，切除了肾盂输尿管狭窄处及肌细胞发育异常的部位，吻合口宽阔、低位、漏斗形，使连接部蠕动能力恢复，     

先天性肾积水肾脏纤维化机制的研究进展

先天性肾积水是小儿泌尿外科常见疾病,发病原因主要是：肾盂输尿管连接处梗阻（UPJO）、输尿管末端狭窄、膀胱输尿管反流、后尿道瓣膜以及神经源性膀胱等。其中UPJO所致小儿肾积水最常见,发生率约1／600～1／800,肾盂输尿管连接部狭窄、息肉、瓣膜以及高位输尿管、迷走血管压迫和腔静脉后输尿管等是UPJO发病的主要病因。此外,肾盂输尿管连接部平滑肌细胞异常,大量胶原纤维沉积,导致蠕动功能障碍,也发挥着重要的作用。     

血小板源性生长因子受体α阳性细胞在先天性肾盂输尿管连接部梗阻发病中的表达及意义

目的探讨血小板源性生长因子受体α(platelet-derived growth factor receptor alpha-positive,PDGFRα)阳性细胞在儿童先天性肾盂输尿管连接部梗阻(ureteropelvic junction obstruction,UPJO)发病中的表达与意义。方法应用免疫组织荧光双染方法对首都医科大学附属北京儿童医院30例UPJO患儿肾盂输尿管连接部(ureteropelvic junction,UPJ)组织(为UPJO组)及10例因肾脏肿瘤行肾输尿管切除术患儿的UPJ组织(排除肾盂输尿管连接部狭窄以及其他泌尿系统畸形,病理结果证实肿瘤未侵犯肾盂输尿管交界处,为对照组)进行染色观察,同时分析所有患儿PDGFRα阳性细胞表达的小电导钙离子激活钾离子通道3型(small conductance calcium-activated potassium channel 3,SK3)表达水平。结果PDGFRα阳性细胞表型区别于Cajal间质细胞,与平滑肌细胞、神经纤维关系密切。PDGFRα细胞在UPJO组中的分布与对照组相似,而该细胞表达的SK3通道在UPJO组中显著低于对照组。结论UPJO患儿肾盂输尿管连接部PDGFRα细胞上SK3通道表达降低,推测SK3通道可能通过干扰UPJ蠕动参与UPJO发病过程。     

经肋脊角小切口入路离断式肾盂成形术48例

目的介绍经肋脊角小切口入路离断式肾盂成形术治疗肾盂输尿管交界处狭窄（UPJO）所致肾积水的方法及疗效。方法2007年1月至2008年10月,对本院收治的48例UPJO患儿经肋脊角小切口入路（A组）行离断式肾盂成形术,与同期70例常规手术入路（B组,包括经腰以及经上腹横切口腹膜外入路）、28例腹腔镜后腹膜入路（C组）进行出血量、手术时间、术后恢复（包括肾周引流量、拔除肾周引流管时间、肠道恢复时间）、手术效果、年龄、肾积水程度的比较。结果①术中出血量：A组与C组相当（P〉0．05）,较B组少（P〈0．05）;手术时间A组最短（P〈0．05）;②术后恢复情况：A组与C组相当（P〉0．05）,短于B组（P〈0．05）;③手术效果：各组一致（P〉0．05）;④各组年龄结构与肾积水程度：A组与B组分布均匀（P〉0．05）,与C组存在差别（P〈0．05）。结论经肋脊角小切口入路行离断式肾盂成形术治疗小儿UPJO,具有切口小,损伤少,出血少,手术时间短,恢复快等优点。     

先天性肾盂输尿管连接部梗阻突触素和神经丝蛋白表达的研究

目的 通过先天性肾盂输尿管连接部梗阻(UPJO)突触素和神经丝蛋白的表达,对UPJO神经肌肉连接进行研究,探讨UPJ0发病机制.方法 应用免疫组化技术对20例先天性.肾盂输尿管连接部梗阻患儿和10例肾母细胞瘤患儿的标本在神经肌肉连接处行突触素和神经丝蛋白标记,光镜下观察其免疫反应表达.结果 对照组突触素和神经丝蛋白的免疫反应阳性表达,实验组突触素和神经丝蛋白免疫反应呈阴性表达.结论 UPJO狭窄部位突触素和神经丝蛋白的异常表达与UPJO的发生有关,病变段输尿管平滑肌处于失神经支配状态,Cannon定律是UPJO病理生理合理的解释.     

两种输尿管不全梗阻肾积水动物模型制作方法的比较

目的 比较两种输尿管不全梗阻致肾积水动物模型制作方法的优劣.方法 将10周龄雄性新西兰兔24只随机分为腰大肌组和塑料套管组,每组12只,分别应用腰大肌包埋输尿管法及塑料套管压迫法制作右侧肾盂输尿管连接部梗阻动物模型.模型建立前后10周分别对两组样本行核医学肾动态显像及CT灌注扫描,测得肾小球滤过率（GFR）、肾实质厚度、肾盂前后径、肾皮质及髓质的血容量（BV）、血流量（BF）、平均通过时间（MTY）及表面通透性（PS）等,并以血肌酐、尿素氮、B超及病理检查为佐证,观察两组样本各项参数的变化,进行统计学分析.结果 两组样本右侧肾脏均呈慢性肾积水表现,血肌酐、尿素氮较术前升高,两组右肾GFR、肾实质厚度以及CT灌注参数BV、BF、PS均较术前下降,但套管组下降更为明显（P〈0.05）;两组右肾肾盂前后径较术前增大,套管组增大更为明显（P〈0.05）.结论 两种方法制作肾盂输尿管连接部梗阻模型均具可行性.但塑料套管压迫法制作模型较为稳固,肾积水效果显著,相比于腰大肌包埋输尿管法具有一定的优势,可作为肾积水模型的优先选择方法.     

腹膜后腹腔镜下Anderson-Hynes手术

目的 介绍腹膜后腹腔镜肾盂成形术。方法 采用后腹腔途径对5例确诊为肾盂输尿管连接部(UPJ)梗阻的患儿施行腹腔镜离断性肾盂成形术。结果5例手术全部成功，手术时间130～190min。术中出血20～50ml，术后3～24个月B超复查，手术侧肾积水基本消失，3例术后1年IVU检查UPJ吻合口无狭窄，肾盂输尿管排尿功能好。结论后腹腔镜离断性肾盂成形术是治疗UPJ梗阻有效、安全及微创的方法。     

腹腔镜辅助经腹路径双侧肾盂成形术的临床应用

目的 探讨腹腔镜辅助经腹路径肾盂成形术在儿童双侧肾盂输尿管连接部梗阻中的应用.方法 2007年2月至2011年1月,收治12例双侧肾盂输尿管连接部梗阻肾积水患儿,男8例,女4例;年龄2～10岁,平均年龄4.9岁;12例均采用腹腔镜辅助经腹路径肾盂成形术.结果 12例手术成功11例,中转开放手术1例.手术时间120 170 min,平均140 min;术中出血20～50 ml,平均25ml.无严重围手术期并发症发生.全部获得随访,术后B超随访肾积水明显改善.结论 腹腔镜辅助经腹路径肾盂成形术治疗双肾盂输尿管连接部梗阻创伤小,安全,有效,有很好的应用前景.

Abstract：

Objective To study the application of transperitoneal laparoscopy-assisted dismembered pyeloplasty in children with bilateral ureteropelvic junction obstruction (UPJO). Methods From Feb,2007 to Jan 2011 ,a total of 12 children with bilateral UPJO underwent transperitoneal laparoscopy-assisted dismembered pyeloplasty. Among them, there were 8 boys and 4 girls. The ages ranged from 2 to 10 years(mean,4. 9 years). Results Eleven operations were completed successfully, 1 case was converted to open surgery. The operation time was 120～170 min (mean: 140 min); The estimated intraoperative blood loss was 20～50ml (mean:25 ml). No serious perioperative complication occurred.The twelve cases wer followed up, Ultrasound examinations after the procedure showed the hydronephrosis was improved. Conclusions The application of transperitoneal laparoscopy-assisted dismembered pyeloplasty with bilateral UPJO is a minimally invasive,safe and effective procedure for treating bilateral UPJO.     

Changes in Structure,Interstitial Cajal-like Cells and Apoptosis of Smooth Muscle Cells in Congenital Ureteropelvic Junction Obstruction

Objective: The goal of this study is to evaluate some structural changes in muscular, collagenous and neural components as well as expression of Cajal-like cells and apoptosis of smooth muscle cells in congenital ureteropelvic junction obstruction (UPJO). Methods: Tissue specimens were obtained from 25 patients with UPJO and compared with normal ureteropelvic junction regions of 19 autopsies. In paraffin embedded sections the amount of Cajal-like cells, density of nerve fibers and smooth muscle cell apoptosis (using immunohistochemical staining) were determined. Collagen deposition and muscular components were stained by Trichrome-Masson staining and evaluated by image analysis techniques. Arrangement of muscular bundles was also evaluated qualitatively. Findings : The number of Cajal-like cells was significantly lower in patients than in controls. The apoptotic score and mean number of nerve fibers were not statistically different for the two groups. Arrangement of muscular fibers was more irregular in patients than in controls (P<0.001). Collagen deposition was significantly higher in patients than in controls (P<0.001). The mean amount of muscular component was lower in patients than in normal ones. (P= 0.09) Conclusion: We found significant pathologic changes in congenital ureteropelvic junction obstruction such as decrease in Cajal-like cells, increase in collagen deposition and irregular arrangement of muscle fibers.Key Words: Uretero-Pelvic Junction Stenosis, Image Analysis, Immunohistochemistry, Interstitial Cell of Cajal-Like Cells     

小儿输尿管息肉致梗阻性肾积水

目的探讨小儿输尿管息肉致梗阻性肾积水的临床特点及诊治方法。方法回顾分析1987～2005年收治33例小儿输尿管息肉致梗阻性肾积水的临床资料，男32例，女1例，左侧27例，右侧5例，双侧1例。就诊年龄5～14岁，平均9岁，病程1个月至5年，平均1年7个月，发病年龄4～12岁，平均7岁。结果33例患儿行手术治疗，手术及术后病理证实肾脏积水为输尿管息肉造成梗阻所致，术后6～12个月行IVP检查，肾积水缓解或减轻，腹痛症状消失，随访6个月至18年未见息肉复发。结论输尿管息肉致梗阻性肾积水以男孩多见，且以学龄儿童为主，多发生在左侧，临床表现和其他原因引起的肾积水类似，但腹痛较剧烈，积水多不重。治疗根据息肉的位置及大小决定手术方案，包括息肉段输尿管切除＋肾盂输尿管吻合，及息肉段输尿管切除＋输尿管一输尿管吻合。     

Comparison of surgical outcomes and cosmetic results between standard and mini laparoscopic pyeloplasty in children younger than 1 year of age

ObjectiveTo evaluate safety, efficacy, and cosmetic results after mini laparoscopic (mL) pyeloplasty and standard (sL) pyeloplasty in children younger than 1 year of age with ureteropelvic junction obstruction (UPJO).Materials and methodsFrom August 2009 to March 2011, 20 sL pyeloplasties were performed in pediatric patients younger than 1 year of age; afterwards, 20 patients younger than 1 year of age underwent mini laparoscopic (mL) pyeloplasty from June 2011 to August 2012. The patients were followed by urine culture and ultrasonography at 3 and 6 months after surgery. Cosmetic appearance was assessed in all patients in both groups group 3 months after surgery using the Patient Scar Assessment Questionnaire.ResultsPeri and postoperative results revealed that operative time (total and anastomosis of ureteropelvic junction), hospital stay, and overall complication rate were significantly lower in mL than in sL. Persistent hydronephrosis in follow-up imaging and recurrence of obstruction was not observed in any cases. Mean appearance score and consciousness score showed significantly better results in the mL group.ConclusionWe believe that mL pyeloplasty in infant cases with UPJO is more cosmetically pleasing and less invasive than sL pyeloplasty and has similar functional outcomes.     

Reconstructive surgery for lower pole ureteropelvic junction obstruction associated with incomplete ureteral duplication

IntroductionThe lower moiety of duplex kidney can be associated with ureteropelvic junction obstruction (UPJO). Surgical correction can be challenging in cases of incomplete duplication where the junction of the lower and upper pole ureters is proximal. We review our experience with this unusual entity with an emphasis on surgical techniques employed in reconstruction.MethodsWe retrospectively reviewed the charts of eight patients with lower pole UPJO who underwent surgery in 2002–2008. The surgical approach, specifically the utilization of the non-obstructed upper pole ureter, used in the reconstruction was noted.ResultsFour of eight patients were symptomatic at presentation with either infection or pain. UPJO was at least in part secondary to lower pole crossing vessels in four patients and was treated with dismembered pyeloplasty. Lower pole to upper pole pyeloureterostomy was necessary in four patients due to short ureteral length between the UPJ and junction of lower and upper pole ureters. No complications or obstruction of either moiety developed during 1 year of follow up.ConclusionsLower pole UPJO in incomplete renal duplication mandates individualized surgical treatment dependent upon anatomy encountered. We have found that pyeloureterostomy is a safe alternative to drainage of the obstructed lower pole.     

微创小切口治疗婴幼儿肾积水后再手术的回顾性分析

目的:探讨腰背部微创小切口手术治疗肾盂输尿管连接处狭窄后再手术方法的局限性及适应证。方法:自2009年12月至2017年12月,广州市妇女儿童医疗中心小儿泌尿外科共收治492例婴幼儿,均采用腰背部微创小切口为入路治疗肾盂输尿管连接处狭窄性肾积水,手术3～6个月后出现肾积水进行性加重、需要二次手术5例;同期收治外院采用同...