42例腹膜后纤维化致肾积水患者外科治疗效果分析

目的：对腹膜后纤维化肾积水患者外科处理后分析评价治疗效果。方法：回顾性分析2008年3月-2012年12月收治的42例腹膜后纤维化肾积水患者,并根据患者的病情不同分别采用单纯输尿管置管术14例,开放性输尿管腹腔内松解术26例,肾造瘘术2例。观察术后肾积水缓解、肾功能恢复情况并随访。结果：42例腹膜后纤维化肾积水患者中,35例接受外科治疗的患者其临床症状减轻或完全消失,肾功能得到了有效的改善;7例输尿管松解术后患者肾功能未能得到缓解,可能与术中输尿管松解不彻底或长期肾后性梗阻致不可逆性肾性肾功能不全有关。结论：腹膜后纤维化引起肾积水、肾功能不全的治疗原则是尽早解除输尿管梗阻,防止肾积水加重和肾功能的进一步恶化,外科处理效果明显。     

双垂直法肾折叠和固定术治疗巨大肾积水

目的探讨肾积水患者的术前肾功能评价的方法，评价双垂直法肾折叠和固定术存治疗巨大肾积水患者中的作用。方法通过．系列指标对巨人肾积水患者肾功能作充分评估，对19例巨大肾积水患者在去除梗阻原因的同时，用双垂直法行肾折叠和固定术行保肾手术。结果19例患者手术顺利，无严重的并发症。术后随访5个月-3年，患者肾积水均显著减轻，2例肾积水消失，患肾山现不同程度的显影。结论术前对巨大肾积水患者的肾脏功能作充分评估有重要意义，对有功能的巨大积水肾行双垂直法肾折叠和固定术，可促进肾形态和功能的恢复。     

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。     

肾盂输尿管连接部梗阻的诊治进展

肾盂输尿管连接部梗阻(Pelvic ureter junction Obstruction,PUJO)为原发性肾积水最常见的原因。近年来随着医疗技术水平的提高,对本病的诊断及治疗也有了较大的进展。一、PUJO诊断方法的改进 PUJO可引起肾积水,但肾积水并非一定有梗阻存在,如肾盂、肾盏或输尿管的肌肉及弹力组织张力减低,或长期梗阻导致肌肉组织被纤维组织代替,即使解除梗阻,上尿路扩张亦不能完全恢复正常。     

积水肾肾功能检测指标的评估

肾积水是泌尿外科常见病之一.积水肾肾功能受损的原因既有肾盂压力升高,又有缺血的存在.目前对肾积水的手术时机及术后积水肾肾功能能否恢复存在许多不同的看法.临床上许多肾积水患者在手术解除梗阻后,其肾功能无明显改进[1,2];原发性肾积水动物模型实验发现并非所有肾脏都有进行性肾积水发生,部分达到一种平衡,肾盂不再扩张,肾功能保持良好[3,4].这说明肾积水分为"进展期"和"平衡期"."进展期"解除尿路梗阻能改善肾功能,而"平衡期"解除梗阻则不能改善肾功能[5].目前有关人类肾积水术后肾功能恢复情况尚无详尽资料,临床上也无法区别肾积水处于何期.     

经皮肾穿刺造瘘在梗阻性肾功能不全中的临床价值

目的：探讨经皮肾穿刺造瘘（PCN）在梗阻性肾功能不全诊治中的临床价值。方法：对49例梗阻性肾功能不全患者在B超引导下行PCN引流肾积水（脓）,经造瘘管造影了解梗阻原因及部位,病情好转稳定后手术解除梗阻。结果145例患者经引流后BUN、Cr均有下降,手术解除梗阻后恢复好。4例患者经引流后BuN、Cr无明显下降,继续行血透治疗。无死亡病例。结论：在梗阻性肾功能不全的诊治中,PCN能尽快引流肾积水（脓）,改善肾功能,避免血液透析或减少血透次数,减轻患者经济负担;可动态监测肾功能变化,避免治疗上的盲目性;建立的通道为二期手术打开方便之门,尤其是结石梗阻性肾功能木全诊治具有重要的应用价值;使急症手术变为择期手术,降低了手术死亡率及术后并发症发生率;同时经肾造瘘管造影可提高诊断符合率。这种方法微创安全,简单有效,经济实惠,值得推广。     

小儿多发性上尿路结石梗阻致急性肾功能衰竭的诊断及早期处理

目的：提高小儿上尿路多发性结石的诊断及早期治疗水平。方法：回顾性分析32例小儿上尿路多发性结石致急性肾功能衰竭的诊断及早期治疗过程，总结出较好的早期诊断与治疗的方法。结果：32例患者经腹部平片(KUB)及B超检查确诊27例，5例另行CT检查而确诊，32例患者均急诊处理，其中5例行输尿管镜碎石、4例经小儿膀胱镜置人小儿双J管而解除梗阻，23例经小儿膀胱镜置小儿双J管失败后，经常规手术解除梗阻，术后肾功能恢复良好。结论：小儿上尿路多发性结石致急性肾功能衰竭须早期诊断及治疗，KUB及B超检色是较好的诊断方法，应以简单、有效、创伤小的方法解除梗阻，可光用内镜方法治疗，如失败，则应急行常规手术解除梗阻。结石可留作Ⅱ期处理。     

急性肾后性肾功能不全的原因及综合处理（附6例报告）

目的：探讨急性肾后性肾功能不全的原因及临床处理。方法：回顾性分析2003～2008年6例肾后性肾功能不全患者的临床资料,总结治疗方法。结果：上尿路梗阻原因5例,其中盆腔肿瘤3例,子宫颈癌2例,子宫内膜癌1例;孤立肾、输尿管结石1例;乙状结肠癌根治术后造成双侧输尿管下段压迫1例。下尿路梗阻原因1例,为BPH并发尿潴留。急诊行输尿管逆行双J管置入术3例,其中双侧置管1例,单侧置管2例;血液透析后行ESWL1例;B超引导下肾穿刺造瘘术1例;留置尿管肾功能恢复后行TURP术1例。6例患者梗阻解除后,3～10天肾功能有不同程度恢复。结论：导致急性肾后性肾功能不全的原因众多,以肿瘤、结石、前列腺增生进行性尿潴留为主。急诊处理原则为解除梗阻,改善肾功能。待患者肾功能恢复后,针对不同病因进行治疗。     

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。     

上尿路结石并重度肾积水的处理方法

目的:探讨上尿路结石并重度肾积水的处理方法.方法:对79例上尿路结石并重度肾积水患者,先行患侧经皮肾穿刺造瘘解除梗阻,再根据情况择期行微创经皮肾镜取石术(mPCNL)、输尿管镜气压弹道碎石术(URL)、或开放手术取石及肾切除手术.结果:除肾切除患者外,积水肾功能均获不同程度改善,全部患者症状缓解,痊愈出院.结论:对于上尿路结石并重度肾积水,先行积水肾经皮肾穿刺造瘘,根据结石大小、部位、梗阻程度及肾功能情况,择期选PCNL、URL或开放手术取石,安全性好,疗效确切.     

经皮肾穿刺造瘘在梗阻性肾积水（脓）中的临床价值

目的：探讨经皮肾穿刺造瘘（PCN）在梗阻性肾积水（脓）中的临床应用价值.方法：对86例肾积水（脓）患者先行超声引导经皮肾穿刺造瘘引流.待肾功能改善、机体状况好转或经引流及造影确定诊断,其中结石引起的肾积水（脓）69例.非结石性肾积水（脓）17例,合并脓肾31例.52例行经皮肾镜取石碎石术,17例行后腹腔镜肾盂、输尿管切开取石术,6例行肾盂切开取石术后加行肾盂输尿管成型术;5例行输尿管狭窄段切除端端吻合术;3例行肾下盏-输尿管吻合术;3例行输尿管皮肤造瘘术.结果：86例患者均穿刺成功,及时解除梗阻,71例患者肾功能恢复正常;9例肾功能改善,维持在轻中度氮质血症水平;6例肾功能无改善.结论：PCN所建立的通道为缓解病情、病因诊断和二期手术打开方便之门,尤其是对急性梗阻性脓肾及结石梗阻性肾积水（脓）的诊治具有重要的应用价值.     

Ureteropelvic junction obstruction in the newborn

Ureteropelvic junction (UPJ) obstruction is a common cause of hydronephrosis in infants. Newborns with severe obstruction often have marked improvement following correction; therefore early diagnosis and operation is important. From 1973 to 1983, 21 patients were operated on for UPJ obstruction diagnosed under 6 weeks of age. Six patients (29%) had antenatal ultrasonographic diagnosis. The remaining patients were diagnosed by IVP or radionuclide scan for palpable renal enlargment or for associated anomalies. Seventeen had unilateral and four had bilateral obstruction. Twenty-three pyeloplasties, one primary nephrectomy, and one cutaneous pyelostomy with subsequent nephrectomy were done. All pyeloplasties were dismembered, with tailoring of the renal pelvis. Postoperative renal function was followed with radionuclide scan or IVP. Postoperative complications included a single urinary tract infection in three patients and two bowel obstructions. One early postoperative death occurred in an infant with bilateral obstruction who developed congestive heart failure secondary to severe uncontrollable hypertension. There were two other unrelated late deaths. Documented functional improvement with minimal complications follow unilateral or simultaneous bilateral pyeloplasty in newborns with UPJ obstruction.     

核素肾动态显像对宫颈癌患者肾功能及形态检测的评估

目的探讨^99m锝-喷替酸（^99mTc-DTPA）肾动态显像在宫颈癌患者肾功能及形态检测中的应用价值。方法对确诊宫颈癌患者230例分别行双肾B型超声、血肌酐、^99mTc—DTPA肾动态显像。通过对三种检查结果的比较,评价^99mTc-DTPA肾动态显像在宫颈癌患者肾功能及形态检测中的应用价值。结果所有患者的血清肌酐均正常,未检出肾功能异常。双肾B超检出肾积水24例、肾囊肿10例、肾结石5例、单侧肾小20例、双侧肾小8例。^99mTc—DTPA肾动态显像检出单侧或双侧肾小球滤过率（GFR）下降共74例,单侧或双侧肾积水共42例,单侧或双侧肾盏。肾盂排泄欠通畅115例,肾囊肿3例,单侧或双侧肾小28例,双侧肾大11例。结论^99mTc—DTPA肾动态显像能更精确的评价肾功能,同时能了解肾的形态学变化。在宫颈癌的治疗中,^99mTc—DTPA肾动态显像是一项能较全面评价肾脏情况的检查方法。     

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.     

Bilateral milk-of-calcium urine and hydronephrosis

Milk-of-calcium urine associated with hydronephrosis is rare, with only 8 unilateral cases reported previously. We report the first case of bilateral occurrence. Upright films are necessary for making the diagnosis. Although previous reports indicate that the involved kidney has little or no function our patient had only slight impairment of renal function. Nephrectomy should not be done without evaluation of renal function, since some function may be preserved by removing the obstruction that is associated with milk-of-calcium urine and hydronephrosis.     

氨基酸负荷对梗阻肾的肾功能和肾储备功能的影响

为寻求预测梗阻肾肾功能的新方法，用氨基酸负荷（ＡＬ）对２５例双肾积水患者进行肾储备功能测定，并对负荷前后肾小球滤过率（ＧＦＲ）、有效肾血浆流量（ＥＲＰＦ）、肌酐清除率（Ｃｃｒ）、滤过分数（ＦＦ）、ＧＦＲ百分比上升率（％ＧＦＲ）进行比较性研究，以求预测肾功能恢复的客观指标。结果表明：ＡＬ能提高ＧＦＲ、ＥＲＰＦ值，通过Ｃｃｒ对比研究，进一步表明ＧＦＲ增值能反映肾储备功能的变化，增值越高恢复越快，反之亦然。结果认为：肾储备功能的测定可预测肾功能恢复情况，并对肾积水疾病的手术方式选择有一定的指导作用     

Survival in second trimester oligohydramnios secondary to bilateral pelviureteral junction obstruction

The extent and onset of obstruction in hydronephrosis determine the varying degrees of renal impairment. Bilateral hydronephrosis, especially in combination with oligohydramnios, is considered a negative predictor for pregnancy outcome. We describe a case of bilateral pelviureteral junction obstruction causing severe oligohydramnios between 25 and 29 weeks of gestation. The prenatal and postnatal findings and treatment are demonstrated. In the presence of bilateral renal impairment and oligohydramnios, our patient had an unfavorable prognosis. The respiratory and renal function, however, were better than expected. We show how urinary tract reconstruction and neonatal intensive therapy can result in an acceptable outcome.     

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.     

Bilateral hydronephrosis secondary to ileocolic Crohn's disease

Unilateral hydronephrosis can complicate a far from negligible number of patients with Crohn's disease. Bilateral hydronephrosis associated with Crohn's disease is a much more unusual entity. In the other hand, the treatment for this condition is still controversial. We present the case of a 44 year old female with several bowel obstruction episodes caused by ileocolic Crohn's disease. During the last episode she was also diagnosed of bilateral hydroureter and hydronephrosis. After the resolution of the bowel obstruction and the placement of a double J catheter in both ureters, the patient was operated. Ileocolic resection and bilateral ureterolysis with omental wrapping were performed. Although urinary and wound infection complicated the postoperative course, and a enterocutaneous fistula had to be medically treated one year later, the patient is now free of symptoms and her renal function is normal.