不同术式治疗肾盂输尿管连接部梗阻63例报告

目的　探讨肾盂输尿管连接部梗阻的最佳治疗方案。　方法　报告 6 3例 (70侧 )肾盂输尿管连接部梗阻的治疗 ,48侧行Anderson -Hynes肾盂成形术 ,6侧行肾盂瓣输尿管成形成 ,5侧行Y -V成形术 ,11例行肾切除术。 8例巨大及重度肾积水病人在A -H肾盂成形术基础上加肾内翻折叠及肾固定术 ,全部病例均放置输尿管支架引流。 11例患儿应用改良式双J管内引流。　结果　 5 1例随访 6个月～ 5年 ,均治愈。　结论　A -H肾盂成形术为最佳术式 :巨大肾积水A -H肾盂成形术加肾内翻折叠及肾固定术不仅改善外观 ,更利于引流及功能的恢复。改良后的双J管也可用于儿童患者内引流     

离断性肾盂成形术双J管内引流治疗小儿肾盂输尿管连接部梗阻

目的：探讨小儿肾盂输尿管连接部（UPJ）梗阻的手术治疗方法。方法：对34例39侧UPJ梗阻采用离断性肾盂成形术,术中置双J管内引流,术后留置导尿5－7d,4-6周拔除双J管,3－6个月复查。结果：患儿症状消失,患肾积水明显好转,吻合口通畅,均获成功,结论：离断性肾盂成形术是治疗小儿UPJ梗阻的有效方法,成功率高,双J管内引流减少了术后再狭窄的机会,缩短了住院时间,使用安全,。可靠。     

双J管在小儿离断性肾盂成形术中的应用

目的：探讨双J管内引流在小儿离断性肾盂成形术中的应用效果。方法：在离断性肾盂成形术中采用放置双J管作内支架和内引流治疗小儿肾盏输尿管连接部（UPJ）梗阻35例40侧，术后留置导尿5－7天，4－6周拔除双J管，结果：术后无切口感染，漏尿管并发症，患肾积水明显好转，吻合口通畅，结论：双J管具有内支架和内引流的双重作用，并发症少，减少了术后再狭窄的机会，缩短了住院时间，使用安全，可靠。     

肾盂输尿管交界部梗阻的诊治体会(附115例报告)

目的探讨肾盂输尿管连接部梗阻的病理学基础及治疗方法。方法报告115例肾盂输尿管连接部梗阻的治疗,85例行Anderson-Hynes肾盂成形术,20例行Y-V成形术,8例行松解术,2例行肾切除术。12例重度及巨大肾积水患者在肾盂成形术基础上加肾内翻折叠固定术,除肾切除外所有患者均放置支架管引流。结果60例随访6个月~12年,均治愈。结论肾盂输尿管连接部梗阻的病理生理过程均由机械或动力因素所致,手术治疗效果良好。     

肾盏造瘘技术在小婴儿重度肾积水腹腔镜肾盂成形术中的应用

目的探讨小婴儿重度肾积水行腹腔镜肾盂成形术中输尿管双J管置入失败,应用肾盏造瘘替代输尿管双J管引流的效果。方法 2016年4月～2017年6月6例小婴儿重度肾积水肾盂成形术中放置输尿管双J管失败,经肾盏留置吻合口支架管和肾盂造瘘管,替代输尿管双J管的引流作用。术后2～3周拔除吻合口支架管,夹闭肾盂造瘘管行亚甲蓝排泄试验阴性后拔除肾盂造瘘管。结果 6例患儿术中行肾盏造瘘,顺利留置吻合口支架管和肾盂造瘘管,术后肾盂造瘘管引流通畅。拔除吻合口支架管,夹闭肾盂造瘘管和拔管后患儿均无发热、呕吐及哭闹不适。4例术后1、3、6、12个月随访,超声或CT示肾积水明显减轻(肾盂前后径1 cm,肾盏扩张0. 5 cm),肾皮质逐渐增厚至0. 5～1. 0 cm(术前肾皮质最薄处仅1mm),肾脏形态接近正常; 2例患儿术后6个月复查肾核素扫描示分肾功能接近正常,分别为47. 3%、48. 2%(分肾功能50%为正常)。结论肾盏造瘘技术在小婴儿重度肾积水腹腔镜肾盂成形术中的辅助作用确切,效果良好。     

腹腔镜离断式肾盂输尿管成形术治疗UPJO肾积水230例经验总结

目的:探讨腹腔镜离断式肾盂输尿管成形术治疗肾盂输尿管连接部梗阻(UPJO)肾积水的临床疗效及总结手术经验。方法:回顾性分析我院2012年10月～2018年10月收治的230例UPJO患者的临床资料。其中先天性UPJO 180例,获得性UPJO 50例,含肾盂输尿管连接部(UPJ)成形术后狭窄10例,输尿管镜下钬激光碎石或经皮肾镜取石术后狭窄30例及球囊扩张术后狭窄10例。采用经腹腹腔镜行离断式肾盂输尿管成形术,术前及术中对体位、Trocar布置、游离和吻合各环节做了细节优化。术后定期随访,分别于拔除双J管后1、3、6、12个月门诊复查B超检查及尿常规,测量肾盂前后径扩张程度及肾实质厚度。结果:所有手术均成功完成,5例中转开放。平均随访时间12(6～36)个月,B超提示肾积水较术前减轻,部分患者ECT及CTU提示肾实质厚度增加,梗阻程度较前减轻,患肾功能不同程度恢复,术前腰背部不适、腹痛及发热等症状主观上明显改善。6例术后出现UPJ再狭窄,3例经输尿管镜检+双J管再置2个月后拔管梗阻缓解,2例行再次腹腔镜肾盂输尿管成形术后改善,1例失访。结论:腹腔镜离断式肾盂输尿管成形术治疗UPJO肾积水安全、有效,术后并发症发生率低,改善肾积水和肾功能结果满意。严格掌握手术适应证、耐心细致的操作和正确处理术中遇到的困难是做好腹腔镜离断式肾盂输尿管成形术的关键。     

双支肾静脉间输尿管所致狭窄行后腹腔镜下肾盂离断成形术一例报告并文献复习

目的 探讨后腹腔镜手术治疗双支肾静脉间输尿管所致UPJ狭窄的可行性及效果.方法 患者为男性,28岁.左腰部酸痛6个月,于外院诊断为左侧UPJ狭窄、左肾积水,留置左输尿管支架管3个月后拔除.B超检查示左肾积水、左侧UPJ狭窄,CT示左侧UPJ狭窄,狭窄处与左肾静脉关系密切,且走行于双支肾静脉之间.肾图示双肾功能受损,左肾GFR 35 ml/min,右肾GFR34 ml/min,左肾积水,左侧上尿路机械性梗阻.全麻下行后腹腔镜下左肾盂离断成形术. 结果 手术顺利,术中发现左肾静脉为双支,左肾盂输尿管在肾静脉间穿行,位于腹侧的一支肾静脉主干压迫左UPJ,同时存在肾迷走动脉与输尿管伴行入肾.术中切除狭窄段约0.5 cm后将输尿管绕行至腹侧肾静脉分支前方,将肾盂成形后与输尿管吻合,同时留置输尿管支架管.手术时间240 min,出血量50 ml,术后住院4d,无发热、术后大出血等并发症.术后随访4个月,复查B超示肾积水明显减轻.结论 双支肾静脉间输尿管所致UPJ狭窄临床罕见,可行后腹腔镜下肾盂离断成形术,创伤小,短期随访效果满意.     

双J管在离断性肾盂成形术中的应用

<正> 自1995年8月以来,我们在离断性肾盂成形术中应用双J管作输尿管内支架和内引流,取代以往放置输尿管外支架管并肾造瘘的方法治疗肾盂输尿管连接部(UPJ)狭窄并肾积水31例38侧,取得了满意的疗效,现报告如下。 1 资料与方法 1.1 一般资料:本组31例38侧,男25例,女6例,年龄6～20岁,平均18.5岁。左侧19例,右侧5例,双侧7例。病人术前有腰部胀痛不适,有不同程度的血尿。体检发现有腰腹部包块。术前行B超检查示肾积水。行腹平片加IVU及逆行插管造影(必要时)确诊为UPJ梗阻。8例并发有肾盂结石,7例     

离断性肾盂成形术治疗肾盂输尿管连接部狭窄

目的：探讨肾盂输尿管连接部狭窄的手术治疗方法。方法：采用离断性肾盂成形（Anderson-Hynes术）加肾、输尿管造瘘及内支架引流术治疗肾盂输尿管连接部狭窄48例。结果：一次手术成功47例,二次手术成功1例。近期并发症1例。48例经8个月－6年随访,远期疗效好。结论：先天性肾盂输尿管连接部狭窄,手术文法以离断性Anderson-Hynes术为首选。双J管能起到引流通畅及内支架作用;儿童患者仍需采用肾、输尿管造瘘引流。     

肾盂输尿管连接部梗阻的诊治体会(附76例报告)

目的探讨肾盂输尿管连接部梗阻的诊治体会。方法回顾性分析76例肾盂输尿管连接部梗阻患者治疗的临床资料。66例行Anderson—Hynes肾盂成形术，2例行Y—v成形术，8例行松解术。结果1次手术成功74例，60例获得随访6个月～12年。1例术后1个月肾盂输尿管连接部狭窄，经再次置入双J管引流3个月治愈；1例行松解术，术后肾积水没有改善。结论Anderson—Hynes肾盂成形术是治疗肾盂输尿管连接部梗阻的首选术式。     

经膀胱镜输尿管双J管置入治疗小儿上尿路梗阻

目的探讨经膀胱镜留置输尿管双J管在小儿上尿路梗阻中的应用价值。方法回顾性分析2014年12月~2018年5月45例膀胱镜输尿管双J管置入治疗上尿路梗阻的资料,其中先天性肾积水20例,急性输尿管结石梗阻23例,肾盂离断成形术后积水复发2例。均经膀胱镜逆行置入F3、F4或F4.7双J管。结果2例先天性肾积水和3例急性输尿管结石梗阻未能置入输尿管双J管,其余40例留置双J管位置良好。先天性肾积水18例均于术后6个月取出双J管,8例随访3~4年积水未加重,10例因积水加重行腹腔镜肾盂离断成形术;急性输尿管结石梗阻20例于1~2周拔除输尿管双J管,二期输尿管镜钬激光碎石成功;肾盂离断成形术后积水复发2例均于术后6个月拔除输尿管双J管,1例随访1年5个月肾积水无再次加重,1例因肾积水再次加重于拔管后20天行腹腔镜肾盂离断成形术。结论输尿管双J管置入可有效缓解小儿上尿路梗阻,达到缓解肾脏压力的目的,可作为婴幼儿和儿童上尿路梗阻的一线治疗方案。     

Late results of pyeloplasty for idiopathic hydronephrosis in adults

A series of 91 cases of unilateral obstruction of the pelviureteric junction is reviewed. Primary nephrectomy was performed in 13 cases (14%) because of severe hydronephrosis and renal function less than 10% that of the normal kidney. Pyeloplasty was performed according to Anderson-Hynes in 74 cases and with a Culp-De Weerd flap in four cases. Nephrostomy was performed concomitantly with the pyeloplasty in 14 cases. The parenchymal function was normal before pyeloplasty in 78% of the 78 kidneys, though the drainage function was severely impaired in 76 of the kidneys and moderately impaired in two. Urine cultures were positive before pyeloplasty in two patients, and 13 of the treated kidneys contained calculi. Follow-up examination was performed 5 to 12 years (mean 8.5 years) after pyeloplasty in all 78 patients. Of the 17 kidneys with preoperatively impaired parenchymal function, 12 (71%) showed improvement. The drainage function was improved in 68 (91%) of the 75 studied kidneys. Persistently impaired drainage function after pyeloplasty was found only in kidneys with infection secondary to retrograde passage of a ureteral catheter for treatment of postoperative urinary leakage. Urinary infection occurred in 11 of the 33 cases with such leakage. Retrograde ureteral catheterization thus favoured the occurrence of urinary infection. Its importance as a risk factor for severe infection was shown by the necessity for secondary nephrectomy in three cases. Since nephrostomy tended to reduce the incidence of urinary leakage, and thereby the need for indwelling ureteral catheter, and since nephrostomy as such was not associated with urinary infection, we recommend its use in the management of idiopathic hydronephrosis.     

Laparoscopic nephroplication and nephropexy as an adjunct to pyeloplasty in UPJO with giant hydronephrosis

Giant hydronephrosis due to uretero–pelvic junction obstruction (UPJO) is rare and usually the treatment is nephrectomy. When renal salvage is required, reconstruction of the UPJ alone is usually inadequate to improve drainage from the pelvicalyceal system. Various open surgical techniques have been described to improve gravity-assisted drainage from the giant hydronephrotic kidney. We describe, for the first time, a complete laparoscopic approach for pyeloplasty combined with nephroplication and nephropexy.     

Pelvi-ureteric junction obstruction in children: the role of urinary transforming growth factor-beta and epidermal growth factor

OBJECTIVES: To investigate the role of transforming growth factor beta(1) (TGF-beta(1)) and epidermal growth factor (EGF) in voided urine for the diagnosis and follow-up of children with pelvi-ureteric junction obstruction (PUJO). PATIENTS, SUBJECTS AND METHODS: The study included 35 children with unilateral PUJO who had a pyeloplasty, and 30 healthy control children. Urine samples were obtained from the bladders of patients before surgery, and as voided samples at 1, 2, 3, 6, 9 and 12 months after surgery. Bladder urine samples were also collected from all 30 children in the control group. TGF-beta(1) and EGF were then measured in all the urine samples. RESULTS: The level of bladder TGF-beta(1) before surgery in the patients was significantly higher than that in the healthy control group. A threshold of 190 pg/mg creatinine gave a sensitivity of 100%, a specificity of 80%, a positive predictive value of 85.4%, negative predictive value of 100% and an overall accuracy of 90.8%. Compared with the value before surgery, urinary TGF-beta(1) was significantly lower at 1 year after pyeloplasty. There was no significant difference between the level of EGF before surgery in the patients and that in the control group, and no significant difference in the level of EGF before and after surgery over the follow-up. CONCLUSION: We do not recommend using EGF levels in voided urine in the routine diagnosis of children with hydronephrosis. The urinary level of TGF-beta(1) is a useful noninvasive tool for the long-term follow-up of children with PUJO treated by pyeloplasty. Further studies with various controls are required to confirm the diagnostic accuracy of TGF-beta(1) in children with PUJO.     

小儿机器人肾盂成形术的经验初探

目的:探讨机器人小儿肾盂成形术的有效性、安全性及病例的选择,总结初步经验.方法:回顾分析2020年8～9月为3例肾盂输尿管连接部梗阻所致的肾盂积水患儿行机器人手术的临床资料,患儿均为男性,分别为4.5岁、7.2岁、5.8岁,术前均经磁共振泌尿系水成像检查诊断为肾盂输尿管连接部梗阻所致的肾盂积水,患侧均为左侧,术前肾盂前...     

后腹腔镜肾盂成形术治疗肾盂输尿管连接部梗阻的临床价值

目的探讨后腹腔镜肾盂成形术治疗肾盂输尿管连接部（UPJ）梗阻的适应证选择、手术技巧及临床应用价值。方法回顾性分析经后腹腔镜肾盂成形术治疗的13例UPJ梗阻患者的临床资料。患者中男7例，女6例，年龄11—47岁。钬激光腔内切开失败1例，高位输尿管开口1例，狭窄段〉2cm或UPJ完全闭锁3例，单纯重度肾积水4例，异位血管压迫2例，合并肾盂结石2例。结果13例手术均获成功。手术时间120～200min，平均175min；出血量60～110ml，平均75ml。术后平均住院时间7．5d（5～8d）。围手术期无并发症。随访3—19个月，UPJ吻合口无狭窄，肾积水、肾功能均得到改善。结论后腹腔镜肾盂成形术是治疗UPJ梗阻的有效、可行的微创手术。可以替代开放手术，成为腔内切开治疗失败、高位输尿管开口、异位血管压迫或伴有重度肾积水、结石的UPJ梗阻患者的首选术式。     

Lower pole pelvi-ureteric junction obstruction in duplicated collecting systems

OBJECTIVE: To determine the incidence and efficacy of treatment for pelvi-ureteric junction obstruction (PUJO, the most common cause of hydronephrosis in the fetal kidney) in duplicated systems. PATIENTS AND METHODS: We retrospectively assessed patients with PUJO in a duplex collecting system, reviewing each case for age, sex, anatomy, presenting symptoms and type of management. RESULTS: From 1994 to 2004, 1413 patients were identified to have hydronephrosis; 243 of them had pyeloplasty for PUJO, and five (2%) involved the lower pole of a duplicated collecting system. In two of the patients the presentation was prenatal hydronephrosis (mean age at diagnosis 6 weeks) and the remainder presented with flank pain and pyelonephritis (mean age 5 years); all were boys. There was only one incomplete duplication (Y type). Four patients had a dismembered pyeloplasty and one a ureteric calycostomy. Vesico-ureteric reflux was present in three patients and two required common sheath reimplantation. On a radioisotope scan during the follow-up (mean 12 months) the five patients showed an improvement and no evidence of functional obstruction. CONCLUSION: The incidence of PUJO in duplicated systems was 2%; treatment should be individualized and requires a careful preoperative evaluation. This anomaly appears to be more common in boys and in completely duplicated systems.     

Urological emergency in neonates with congenital hydronephrosis

OBJECTIVE: It is well described that unilateral pelviureteric junction obstruction (PUJO) is a benign condition, because the dilatation resolves spontaneously and the function does not decrease in most of the kidneys. However, there is exceptional PUJO that requires emergent treatment in neonatal periods. The aim of this article is to report the urological emergency and management in neonates with PUJO. MATERIALS AND METHODS: Nine children (seven boys and two girls) with PUJO who underwent neonatal emergent treatment during the last 13 years were reviewed. Renal function was evaluated according to decay curve of serum creatinine (SCr) levels corresponding to gestational age (GA) at delivery. Physical examination, ultrasonographic monitoring, and chest and abdominal plain radiographs were repeated in each neonate. RESULTS: Eight patients were detected prenatally. In five patients, multicystic dysplastic kidney (MCDK) was demonstrated on the contralateral side. Three patients underwent percutaneous puncture of fetal hydronephrosis. Decrease of amniotic fluid was evident in three fetuses. Indications for emergent treatment included mass effect from hydronephrosis in three patients, renal dysfunction in five, and severe urinary tract infection in one. During neonatal periods, a percutaneous nephrostomy tube was placed in seven, and open nephrostomy in one with anorectal malformation. Repeated punctures of the dilated renal pelvis were done in one patient. Renal function after pyeloplasty was stable in eight patients, while it was moderately decreased in one who was associated with oligohydramnios in utero. CONCLUSION: Indications for emergent treatment in neonates with PUJO included mass effect from giant hydronephrosis, renal dysfunction and severe urinary tract infection. At birth, respiratory and circulatory conditions must first be stabilized. In neonates with hydronephrosis of the solitary kidney or severe bilateral PUJO, serial SCr should be monitored to evaluate renal function. Decrease of amniotic fluid suggested renal functional compromise that would not recover after urological management.     

Usefulness of short-term retrievable ureteral stent in pediatric laparoscopic pyeloplasty

PURPOSE: Methods of stenting after laparoscopic pyeloplasty have included indwelling Double-J stents and percutaneous nephrostomy tubes. The disadvantages of these methods are that they necessitate a second surgery for stent removal or require an external drainage bag. To circumvent these issues, the tolerance, safety and outcomes of using a Double-J ureteral stent with a dangler, permitting early office removal, was investigated in a series of pediatric laparoscopic pyeloplasties. MATERIALS AND METHODS: Medical records from a consecutive series of pediatric patients undergoing transperitoneal laparoscopic pyeloplasties were reviewed. Indications for surgery included ipsilateral flank pain with severe hydronephrosis (12 patients), recurrent pyelonephritis with severe hydronephrosis (2), and hematuria and flank pain (6). All patients were discharged home within 24 to 48 hours of the procedure with prophylactic oral antibiotics. The stent was removed by postoperative day 18 during a followup office visit. Patient tolerance of the indwelling stent, outpatient removal and success of pyeloplasty were assessed. RESULTS: A total of 20 patients underwent transperitoneal laparoscopic pyeloplasty by 1 surgeon (LAB) between 2001 and 2005. All patients underwent cystoscopy and retrograde Double-J ureteral stent placement before pyeloplasty under the same anesthesia. Mean patient age at operation was 11.3 years (median 11.3, range 4.6 to 17.2). Stents were left indwelling for a mean of 10.3 days (median 10, range 7 to 18). All patients tolerated the Double-J stent well, with 2 requiring anticholinergic therapy for mild urgency symptoms and 1 demonstrating urinary tract infection. All patients tolerated outpatient stent removal via the dangler at the office without discomfort. One patient was lost to followup. At a mean followup of 1.04 years (range 0.1 to 2.88) 17 of 19 patients (89%) had resolution of flank pain/urinary tract infections, with sonographic improvement in hydronephrosis with or without endoscopic intervention. Six patients (30%) had flank pain with or without continuous hydronephrosis and required re-stenting, and 3 also required balloon dilation. Of these 6 patients 2 (10%) had recurrent ureteropelvic junction obstruction and required open pyeloplasty. All patients are now clinically and radiologically unobstructed and asymptomatic. CONCLUSIONS: Pediatric transperitoneal laparoscopic pyeloplasty with indwelling Double-J ureteral stent with a dangler is successful and the stent is well tolerated. Whether the duration of ureteral stenting affects the surgical success will require further controlled long-term studies.