巨输尿管症的诊断与治疗

巨输尿管症系输尿管严重扩张以致不能产生有效蠕动而形成,是一种少见输尿管疾病,临床上以腰痛、血尿、尿路感染及继发结石为主要表现,但无特异性,易发生漏诊或误诊。我院自１９８９年９月～１９９７年１２月收治巨输尿管症１１例,报告如下。１　临床资料本组１１例,男８例,女３例,年龄６～４３岁,平均２７岁。病程２０ｄ～１０年,平均１０个月。其中左侧６例,右侧４例,双侧１例。１０例有腰部胀痛,伴肉眼血尿５例。患侧继发肾结石３例,输尿管结石３例,其中肾绞痛反复发作１例,１例有输尿管下段切开取石史。女性３例均有尿频…     

体外冲击波碎石术治疗上尿路尿酸结石

作者采用超声定位的压电晶体式体外冲击波碎石术连续性治疗１２１例上尿路尿酸结石，观察其碎石疗效。肾结石１１２例，共１６７枚，结石长径０．５～３．５ｃｍ，平均０．８６ｃｍ；输尿管结石９例，长径０．６～１．３ｃｍ，平均０．８４ｃｍ。２例输尿管上段结石接受了重定位辅助治疗，其余均采用原位治疗。单次治愈者为８０．９９％，２次者１２．４０％，３次者４．９６％，４次者１．６５％。所有患者术后均未发生严重并发症。作者认为采用超声定位的压电晶体式碎石机治疗尿酸结石是一种较为理想的方法，并侧重探讨了尿酸结石的Ｂ超定位技术、碎石过程中的冲击方法和术后碱性药物的应用。     

巨趾症2例报告

巨趾症２例报告侯新安例１男，１９岁。出生时发现左足第２、３趾较对侧稍大，随年龄逐渐增粗变长，行走不便，无疼痛及感觉障碍，家族中无类似畸形。查体：左足第２、３趾粗大畸形，第２趾较对侧长６ｃｍ，周径粗１．５ｃｍ，第３趾较对侧长５ｃｍ，周径粗１．５ｃｍ，皮...     

彩超诊断182例输尿管结石的临床价值分析

目的探讨超声诊断输尿管结石的声像图特征及临床价值。方法应用二维超声检查及彩色多普勒显像技术检查182例输尿管结石患者,分析其声像图特点及检出率。结果输尿管结石声像图主要表现为扩张的输尿管无回声带,内显示一致密的强光团,伴有声影,强光团呈圆形或长圆形,亦有扁平形或不规则形。全部184个结石二维超声检出率为84%（154/184）,加用彩色多普勒技术扫查伴有＂彩色快闪伪像＂者171个,检出率为93%。结论应用二维超声及彩色多普勒显像技术诊断输尿管结石,显著提高了输尿管结石特别是中段结石的检出率。     

输尿管膀胱肿瘤阴茎转移1例

输尿管膀胱肿瘤阴茎转移１例方俊，姚克家泌尿系肿瘤转移至阴茎海绵体者极为罕见。我院收治１例，曾先后３次手术治疗，尚健在，现报告如下。患者，５０岁。因肉眼血尿伴右腰部疼痛５６于１９９３年６月２８日入院。Ｂ超示右肾积水，右输尿管上段扩张１．１ｃｍ，右输尿管...     

罕见巨指畸形一例

罕见巨指畸形一例赵小平息者女性，６０岁。出生时即发现右手拇、示、中指校对侧为大，后呈进行性长大，至２０岁左右停止生长为目前状态．右１～３指呈“铁锚样”畸形，完全无功能（附图）。示指根部周长约２３ｃｍ，比腕部周长大６ｃｍ。环、小两指正常，能主动伸屈、收...     

小儿输尿管纤维上皮息肉的诊断与治疗

报告４例小儿输尿管纤维上皮息肉，４例病变均起源于输尿管上段，３例呈单发，１例呈多发，患侧胁复中疼痛或血尿为其主要表现，静脉尿路造影及Ｂ超显示患侧输尿管或肾积水，１中行逆行肾盂造影显示输尿管腔内有一球茎形充盈缺损，３例行息肉主病变段输尿管切除，１例行病变段输尿管１部分肾盂切除及部分息肉电灼治疗，结果疗效满意，随访至今无复发，认为对输尿管上段梗阻或主度疑为此病者，采用大剂量静脉尿路造影或逆行肾盂造影可     

颈横动脉颈段皮支岛状皮瓣的临床应用

颈横动脉颈段皮支岛状皮瓣的临床应用马显杰，鲁开化，艾玉峰我科自１９９０年１月～１９９３年３月，应用颈横动脉颈段皮支岛状皮瓣修复烧伤后颠胸粘连１ｌ例，其中男８例，女３例。年龄３～３８岁。病史最长１３年，最短１年。应用皮瓣最大面积１５ｃｍ×ｌ６ｃｍ，最小...     

先天性巨输尿管症的诊治(附17例报告)

目的 探讨先天性巨输尿管症的诊治方法.方法 回顾性分析17例共20侧先天性巨输尿管症患者的临床资料,其中左侧9例,右侧5例,双侧3例.手术治疗14例17侧,其中输尿管裁剪输尿管膀胱吻合术10例13侧,肾输尿管切除2例2侧,输尿管折叠输尿管膀胱吻合术2例2侧,3例3侧行内镜扩张术.结果 随访1-5年(平均3年),经内镜扩张3例,其中1例患者术后临床症状缓解,输尿管扩张有减轻,2例患者症状改善不明显,肾积水、输尿管扩张无明显减轻;14例手术患者中10例获随访,输尿管裁剪、输尿管膀胱吻合术患者中7例示手术侧输尿管扩张明显减轻,1例肾积水无明显减轻.但症状明显改善,2例肾输尿管切除者行B超检查,显示对侧肾脏代偿性增大;全部患者肾功能检查均正常;输尿管功能性梗阻段经病理检查提示环肌肥厚、纵肌减少9侧,其中3侧伴管壁全层炎症改变,管壁胶原组织增生7侧,纵肌增生1侧.结论 MRU检查在先天性巨输尿管症的诊断中有重要意义;输尿管裁剪整形加抗逆流的输尿管膀胱吻合术是治疗先天性巨输尿管症的首选手术方式.     

静脉蒂逆行岛状皮瓣修复指掌侧皮肤缺损

静脉蒂逆行岛状皮瓣修复指掌侧皮肤缺损熊明根，司徒扑，王晋煌，侯文明自１９９０年以来，我们采用带浅静脉干的掌、指背皮瓣逆行转移修复指掌侧及指端皮肤缺损５例，其中外伤性缺损３例，瘢痕切除１例．感染性溃疡创面１例。皮瓣大小为５ｃｍ×３ｃｍ～３ｃｍ×２ｃｍ，...     

先天性巨大输尿管积水的诊断与治疗(附六例报告)

目的　提高先天性巨大输尿管积水的诊治水平。　方法　对 6例病例资料进行回顾性总结并从胚胎学、诊断及治疗方法方面进行探讨。　结果　 6例病人均有输尿管极度迂曲、扩张 ,并伴有肾发育不全 ,采用患侧肾、输尿管全切除术取得良好效果。　结论　结合病史、查体及B超、CT及IVU检查可确定诊断 ,手术切除发育不全的小肾脏及扩张的输尿管是主要治疗方法     

小儿腹腔镜下巨输尿管成形术

目的 探讨小儿腹腔镜下输尿管铲状乳头膀胱再植术的可行性和临床效果.方法采用经膀胱外途径行腹腔镜下输尿管铲状乳头膀胱再植术治疗先天性梗阻性巨输尿管症患儿11例.年龄11个月～13岁,平均(5.3±3.9)岁.左侧4例,右侧7例.其中输尿管出口闭锁1例、单纯性输尿管出口狭窄9例、开放输尿管膀胱再植术后(Cohen手术)输尿管出口狭窄1例.B超和IVU示重度肾积水7例、中度肾积水4例. 结果 11例手术均获成功.手术时间70～190 min,平均(103.O±35.3)min.术中出血10～40 ml,平均(18.0±9.5)ml.术后住院时间7～10 d,平均(8.0±1.4)d.无尿漏发生.术后6周拔除双J管,膀胱镜或输尿管镜下见膀胱输尿管吻合口已黏膜化,乳头收缩抗反流效果满意;11例平均随访6(3～24)个月,B超复查患侧肾积水减轻;IVU示成形输尿管排尿好,无梗阻,症状基本消失;膀胱造影未见膀胱输尿管反流. 结论 在熟练掌握腹腔镜操作技术后,应用经膀胱外途径腹腔镜下输尿管铲状乳头膀胱再植术治疗小儿梗阻性巨输尿管症创伤小、抗反流效果好,是治疗小儿梗阻性巨输尿管症的微创新途径.     

先天性巨输尿管症的诊治体会（附9例报告）

目的：探讨先天性巨输尿管症的诊治特点。方法：9例先天性巨输尿管症,其中左侧4例,右侧2例,双侧3例。主诉症状不典型,最终经B超、KUB＋IVP、膀胱镜逆行插管造影、CT、MRU等检查确诊。采用输尿管中、下段裁剪、坑逆流输尿管膀胱再植术5例。1例先行肾盂穿刺造瘘术,3个月后行输尿管膀胱再植术。因肾重度积水,功能严重受损而行。肾、输尿管切除术1例。1例行输尿管末端切开术。1例行保守治疗,定期更换双J管。结果：输尿管膀胱再植术6例（包括先行肾盂穿刺造瘘术,3个月后再行输尿管膀胱再植术的患者）,均于6-12周后拔除支架管或双J管（幼儿患者约6周拔除支架管导尿管,成人患者约2-3个月拔除双J管）。术后随访经B超及静脉肾盂造影检查,显示患侧输尿管扩张度和肾积水均明显减轻。1例行输尿管末端内切开术的患者在术后3个月拔除并更换双J管1次,复查B超亦提示恢复良好。保守治疗的1例患者到目前为止,病情尚无恶化征象。结论：B超和KUB＋IVP检查是诊断先天性巨输尿管症的首选检查方法,但MRU近年体现出更多的诊断优势。治疗本症的原则是解除梗阻,尽量保留肾功能。手术方式以输尿管剪裁或折叠加输尿管膀胱吻合术为主,但腹腔镜和内镜手术也逐渐受到重视。肾功能尚好者也可行扩张或放置内支架等保守治疗。     

Congenital giant megaureter

We have seen 21 patients with unilateral congenital giant megaureter. Age ranged from 2 months to 8 years. This condition is characterized by giant focal segmental ureteral dilatation producing an elongated and distorted ureter; distally there may be congenital ureteral stenosis or atresia, or a ureter of approximately normal caliber. They usually have a dysplastic and disorganized muscular coat, lined with a columnar epithelial mucosa rather than the usual transitional epithelium. The associated kidney or moiety was hypoplastic, dysplastic, or the site of comparatively mild hydronephrosis associated with atrophic renal parenchyma. Function and volume of the bladder was normal. Twelve of 21 patients had a duplex collecting system on the affected side. One patient had four pelves and proximal ureters opening into a single lower ureter, which was the site of a giant cyst. One of eight simple giant megaureters was suspected of being associated with a solitary kidney. Depending on whether the giant segmental ureteral dilatation was multiple or single, these cases have presented either with marked protruberance of the mid and lower abdomen, which was distended by transverse elongated cysts, or with a round cyst mass in the lower abdomen. Nineteen patients treated by excision of the giant megaureter and the associated kidney or moiety were free of symptoms postoperatively. One 4-month-old infant with multiple congenital abnormalities and urinary tract infections died soon after operation. Another 4-month-old infant with suspected solitary kidney was treated by ureterostomy and was discharged in a critical condition without follow-up.     

Urolithiasis in adults with congenital megaureter

The primary presentation of congenital megaureter in adults is rare. Development of urolithiasis may lead to this unusual underlying diagnosis. Urinary tract stones can form either within the dilated ureteral segment or in a part of the upper urinary tract proximal to the abnormal ureteral segment. We report two cases of nephrolithiasis that occurred in adults found to have segmental megaureter. The first case is that of a 58-year-old man who presented with left lower quadrant pain. Computed tomography scan revealed a 2-cm stone in the distal left ureter within an area of isolated segmental distal ureteral dilation. The second case is a 48-year-old man who developed recurrent renal urolithiasis associated with isolated distal megaureter.Although a rare condition in adults, congenital megaureter may present when kidney stones develop as a result of the ureteral abnormality. Typically, stones will develop within the dilated segment of ureter. Atypically, stones may develop away from the site of the underlying abnormality. Congenital megaureter is a diagnosis that urologists and radiologists need to consider in the setting of isolated distal ureteral dilation, as the diagnosis of adult megaureter may require more involved surgical measures to prevent recurrence of adverse symptoms.     

成人先天性巨输尿管症37例诊疗分析

目的：探讨成人先天性巨输尿管症（CM）的诊治方法.方法：回顾性分析37例成人CM的临床资料：男18例,女19例.左侧18例,右侧10例,双侧9例.超声检查、静脉尿路造影（IVU）检查提示输尿管全段扩张伴肾盂积水22例,输尿管下段扩张9例.IVU不显影或显影不清13例;同位素肾动态显像检查提示患肾不同程度损害.手术治疗34例,其中行肾输尿管切除术2例,输尿管膀胱再植术32例.间断性双J管置入1例,保守观察2例.结果：随访32例,随访时间4个月～20年.患侧肾输尿管积水减轻29例,无明显变化3例.结论：成人CM的诊断主要依据影像学检查.治疗原则为解除梗阻、尽量保留息肾功能,应根据输尿管扩张程度选择输尿管折叠或裁剪加输尿管膀胱再植术,吻合方法推荐Lich-Gregoir术式;肾功能良好、无明显症状者可保守治疗.     

成人先天性巨输尿管症(附35例报告)

目的：探讨成人先天性巨输尿管症的诊治特点，方法：35例成人先天性巨输尿管症，其中左侧14,全然中侧11例，双侧10例，所有病例均行B超，IVU检查，手术治疗31例39侧，其中肾输尿管切除术12例，输尿管剪裁整形或折叠后行输尿管膀胱再植术27例，结果：29例获得随访，随访时间1－5年，术侧肾输尿管积水37侧减轻，2侧无明显变化。结论：B超，IVU检查是成人先天性巨输尿管症的首先检查方法。治疗本症的原则是解除梗阻，尽量保留肾功能，手术方式是输尿管剪裁或折叠加输尿管膀胱吻合术，肾功能良好者也可保守治疗。     

先天性巨输尿管症25例

目的：探讨先天性巨输尿管症的诊治方法。方法：报告25例先天性巨输尿管症，其中左侧13例，右侧10例，双侧2例。25例中行肾输尿管切除术6例，行输尿管膀胱吻合术12例。结果：12例输尿管膀胱吻合术均成功。结论：儿童患应尽早手术治疗，成人患可根据病变采用保守或手术治疗。治疗本症的原则是解除梗阻，尽量保留肾功能。理想的手术方式是输尿管裁剪加输尿管膀胱吻合术。     

Two cases of megaureter in children

We reported 2 cases of megaureter in children. The courses of renal function and ureteral dilatation in these patients were observed by urography and renoscintigraphy to determine the timing of surgery. These two patients with unilateral megaureter were treated by reconstructive operation involving excision of the stenotic portion of the ureter, tapering of the dilated ureter and re-implantation. The courses after reconstruction were excellent after 5 years. Recently, active surgery has been recommended for megaureter together with identification of the cause. Urograms and diuretic renoscintigrams were useful for determining the timing of surgery in our cases.     

小儿输尿管疾病的超声诊断

采用经腹壁超声方法，对４０６例输尿管疾病检查诊断，其中肾盂输尿管囊肿６９例、异位开口４８例、双输尿管畸形７例、结石２６例、肾盂输尿管连接处狭窄１４２例、输尿管扩张和巨输尿管症１１４例。小儿输尿管疾病以先天性畸形为主，多需手术治疗。超声诊断能为治疗提供确切依据，符合率较高，该法简便、重复性强、刺激性小，非常适宜小儿检查。