小儿肾重复畸形的诊断与治疗

６５例小儿肾重复畸形，主要表现为泌尿系感染，尿淋漓，排尿困难及腹部包块。最后确诊靠影像学检查。Ｂ超不受肾功能限制；ＳＰＥＣＴ灵敏度高，积水型重肾也可显影。对有症状的重肾，应手术治疗，需切除重复的部分。如其肾功能近于正常，可行输尿管移植术。对其输尿管囊肿，开口异位的处理，除少数病例外，多不必切除。该病治疗效果满意。     

尿路感染患儿行99mTc-EC肾动态显像的临床价值

目的 探讨肾动态显像在小儿尿路感染中的临床应用价值.方法 回顾性分析住院尿路感染患儿的99mTc-EC肾动态显像资料49例,男21例、女28例,平均3.37岁.结果 49例UTI患儿中,确诊合并有先天性尿路畸形者21例(42.86%),其中膀胱输尿管反流10例(47.62%),肾盂输尿管接合部狭窄7例(33.33%),肾重复畸形4例(19.05%).21例合并尿路畸形者中,17例(80.95%)出现肾皮质的形态改变或放射性分布异常,20例(95.24%)出现单侧或双侧肾图异常;而28例无尿路畸形的UTI患儿中,仅有1例(3.57%)出现双侧肾皮质的放射性分布异常,无1例出现单侧或双侧的肾图异常.结论 尿路感染患儿中开展99mTc-EC肾动态显像,可有效检出合并尿路畸形者,使其得到早期合理的治疗.     

核医学肾脏显像对儿童肾积水患者分肾功能的评估价值

核医学肾脏显像包括肾动态显像和肾静态显像.利尿肾动态显像如应用于儿童肾积水患者,在评估分肾功能的同时,可协助判断尿路梗阻的性质.由于婴儿肾脏肾小球发育不成熟,建议行肾动态显像时,＜2岁患者使用肾小管分泌型显像剂99mTc-双半胱氨酸(99mTc-EC),＞2岁者使用肾小球滤过型显像剂99mTc-喷替酸(99mTc-DT...     

56例小儿重复肾临床诊疗分析

目的探讨小儿重复肾的诊断与治疗方法,以进一步规范其诊疗流程。方法对遵义医学院附属医院近10年收治的小儿重复肾畸形56例的临床资料进行回顾性分析。对其临床表现、分型、诊断及治疗方法进行总结分析。结果 56例中重复肾重复输尿管无积水且IVU显影正常者11例,保守随访观察。重复肾发育不良、重复肾积水伴重复输尿管积水并输尿管异位开口、IVU不显影和SPECT检测GFR(肾小球滤过率)无功能35例,予以重复肾重复输尿管探查切除。重复肾功能尚存、重复输尿管扩张(直径大于4. 0 cm)、积水3例,予以重复肾与下位肾肾盂吻合成形术治疗;重复肾功能尚存、重复输尿管扩张(直径小于4. 0 cm)、积水伴输尿管末端囊肿5例(不伴膀胱输尿管反流),予以输尿管末端囊肿戳穿术治疗;不伴输尿管末端囊肿2例,予以重复输尿管膀胱再植术治疗。术后随访6个月至7年,除1例因合并骶脊膜膨出术致神经源性膀胱表现为尿失禁外,其余术前存在泌尿系感染的病例感染症状均消失。术前不存在泌尿系感染的病例术后亦未出现泌尿系新发感染,行输尿管囊肿戳破术及膀胱输尿管再植的病例术后未出现膀胱输尿管反流。结论小儿重复肾畸形临床表现多样,B超、IVU、SPECT、VCUG及泌尿系MRU检查是诊断的主要方法,膀胱镜输尿管插管逆行造影有一定的补充性诊断价值。治疗则应依据重复肾功能、重复肾重复输尿管有无积水以及是否合并重复输尿管异位开口,采用个体化治疗方案。     

重肾双输尿管畸形下肾积水的临床处理

目的 探讨小儿少见的重肾双输尿管畸形下肾部积水功能受损病例的临床特点及治疗方法.方法 报告2004至2007年间我院收治的4例重肾双输尿管畸形下肾部积水功能受损病例,男3例,女1例,年龄为6个月至10岁,其中下肾部并发肾盂输尿管交界部梗阻性肾积水者3例,1例完全型双输尿管者作下肾离断性肾盂成形;另1例不完全型双输尿管者作下肾部肾盂与上输尿管端侧吻合术;下肾部肾巨大积水功能丧失1例作下肾切除.不完全型双输尿管畸形下肾部并发反流积水功能受损1例,作共同通道段输尿管膀胱再植术.结果 经术后6～18个月(平均12个月)随访,经B超、利尿性肾图(DR)及排尿性膀胱尿道造影(VCUG)检查,2例下肾部并发.肾盂输尿管交界部梗阻息儿积水缩小,肾功能提高,1例下肾部反流患儿反流消失.结论 重肾双输尿管畸形下肾部积水,功能受损病例较少见,为取得良好的手术治疗效果则术前需根据不同病例进行仔细地个性化评价.     

小儿重复肾畸形的早期诊断和治疗

目的 探讨小儿重复肾畸形的早期诊断和治疗方法.方法 回顾性分析本院1995年6月-2007年9月60例经手术治疗的小儿重复肾畸形病例的临床资料.60例均行B超检查,确诊55例,误诊为肾上极囊肿5例.60例患儿均行静脉肾盂造影(IVP)检查,均提示重复肾,其中2例上下肾部均有不同程度的肾盂积水和输尿管扩张,进一步行排尿性膀胱尿道造影,诊断下肾部膀胱输尿管返流、下肾部输尿管膀胱交接部梗阻各1例.结果 重复肾畸形患儿60例均行手术治疗,行上肾部切除及其输尿管切除58例,重复肾并上下肾部积水手术2例,其中1例下肾部输尿管末端梗阻致下肾部积水,上肾部输尿管囊肿,行上肾部及其输尿管切除,术后输尿管囊肿萎陷,下肾部输尿管末端梗阻解除,症状消失,术后6个月复查IVP,下肾部肾盏杯口清晰,无肾积水,肾功能良好,疗效满意;另1例为下肾部输尿管返流致下肾部积水,上肾部输尿管囊肿,行输尿管囊肿切除,双输尿管膀胱再植术,术后6个月复查排尿膀胱尿道造影,膀胱输尿管返流消失,排尿正常,无泌尿系感染.结论 术前诊断不明或误诊的原因多系患儿临床症状与其他疾病症状相类似而误诊为其他疾病,应强调对可疑征象的辅助检查.如重复肾畸形诊断明确,应早期手术治疗.     

99mTc-EC肾动态显像在儿童肾瘢痕诊断中的价值

目的探讨99mTc-EC肾动态显像在尿路感染患儿肾瘢痕诊断中的价值。方法回顾性分析同期行99mTc-EC肾动态显像和99mTc-DMSA肾静态显像的67例尿路感染患儿的显像资料,以99mTc-DMSA肾静态显像结果为金标准,分析比较99mTc-EC肾动态显像与尿路感染、肾积水与肾瘢痕的关系。结果99mTc-EC肾动态图起始2 min叠加图像诊断肾瘢痕的灵敏性是80.28%,特异性是88.89%,阳性似然比为7.23。采用99mTc-DMSA肾静态显像诊断肾瘢痕,发现与上尿路排泄通畅和排泄延缓的患儿相比,上尿路排泄梗阻患儿的肾瘢痕形成概率较高,差异有统计学意义(P0.05);但积水程度不同患儿的肾瘢痕发生概率的差异无统计学意义(P0.05)。结论对尿路感染患儿,99mTc-EC肾动态显像早期叠加图像诊断肾瘢痕形成的灵敏性和特异性均较高,99mTc-EC肾动态显像提供的上尿路排泄情况对肾瘢痕形成的诊断具有一定价值。     

小儿重复肾及合并畸形的超声诊断

目的 分析重复肾及合并畸形的超声声像图特征及其对该病变的诊断价值。方法 对照手术病理证实的32例重复肾及合并畸形的超声声像图特征进行总结。结果 超声图像表现重复肾伴积水26例，占71％，其中输尿管开口异位17例，输尿管囊肿9例。重复肾不伴积水6例，表现为两组集合系统。结论 超声检查对重复肾及合并畸形的诊断有可靠价值。     

重复肾输尿管畸形的诊断与治疗

目的 探讨重复肾输尿管畸形的诊断与治疗。方法 16例重复肾输尿管畸形患儿，单侧13例、双侧3例，其中13例伴一侧输尿管异位开口；通过静脉肾盂造影(IVU)、B超、膀胱镜检查确诊；15例行手术治疗，1例保守治疗。结果 经治疗均痊愈出院，术后随访1～8年疗效满意。结论IVU、B超诊断有重要意义，治疗应根据重复肾、输尿管病情及其并发症而定。     

重肾双输尿管合并肾盂输尿管交界部梗阻性肾积水的诊治分析

目的 探讨重肾双输尿管合并肾盂输尿管交界部梗阻性肾积水的诊断与处理方法。方法 回顾分析1986～2004年间收治重肾合并肾盂输尿管交界部梗阻肾积水8例的临床资料。男2例，女6例，年龄7个月～10岁，平均4．8岁。病变位于左侧3例，右侧5例；上肾积水2例，下肾积水5例，上下肾积水1例；3例为重肾完全型双输尿管，5例重肾Y型输尿管。结果 3例重肾完全型双输尿管中，上肾积水1例因肾实质薄无功能行上肾切除术，下肾积水伴上肾输尿管膨出症1例行上肾切除下肾离断性肾盂成形术，另1例下肾积水因临床症状轻微，IVP示积水半肾的肾盏变钝不明显，未行手术门诊随诊。5例重肾Y型输尿管中，上肾积水1例行上肾盂与下输尿管吻合，下肾积水3例行上肾输尿管下肾盂吻合 下肾离断性肾盂成形术，1例上下肾均积水行上下肾盂吻合 下肾盂成形术。术后3～6个月复查IVP肾积水明显好转。结论 重肾肾盂输尿管交界部梗阻肾积水发病率很低，术前不容易明确诊断或被误诊。腹部B超、IVP或MRU是有效的辅助检查手段。治疗应根据息肾功能、形态而定，如息肾功能严重受损，行患肾切除，反之，根据积水的部位、输尿管的形态选择手术方式。     

Multicystic dysplasia in the upper component of the complete duplex kidney

Four cases of neonatal multicystic dysplasia involving the upper part of a complete duplex kidney are presented. This malformation, suspected on antenatal ultrasound examination, was confirmed by postnatal IVP and ultrasound. This emphasizes the need to perform an IVP when the diagnosis of multicystic kidney is suggested by ultrasound. Conservative surgery may then be achieved, as in three of the four cases.     

小儿输尿管膨出症的治疗--附91例分析

目的 选用创伤小，疗效好的术式治疗输尿管膨出症，减法二次手术。方法 91例输尿管膨出症，男25例，女66例，其中70例（76.9%)并发于重肾双输尿管畸形，其中左上输尿管膨出症40例，右上27例，双上3例，影像学检查；双上肾积水4例，患侧上肾积水52例，患侧上下肾积水10例，患侧上，下及对侧都有肾积水4例。21例单一系统输尿管膨出症中，左侧5例，右侧11例，双侧5例。影像学检查；患侧肾积水10例，双侧肾积水5例，患肾功能严重受损5例。上尿路正常1例。结果 78例（85.7%)术后平均随访2年。重肾组；（1）上肾部切除48例52侧，治愈36例，失访7例，需加做输尿管残留切除3例，需再经尿道戳穿输尿管膨出2例；（2）切除输尿管膨出及输尿管膀胱再吻合6例，治愈5例。术后加做上肾部切除1例；（3）经尿道戳穿输尿管膨出15例，治愈9例，失访4例。需加做上肾部切除2例；（4）输尿管膨出自行缩小，症状消失1例。单一系统21例中15例经尿道戳穿输尿管膨出，治愈12例，失访2例，需加做输尿管膀胱再植1例，1例经输尿管膨出切除，输尿管膀胱再植治愈，发育不良肾切除5例。治愈2例，有尿失禁症状2例，仍时有尿路感染1例。全组1次手术治愈65例。结论 输尿管膨出症的治疗须根据患肾功能决定，如患肾功能严重受损，首选患肾或肾部切除，反之则经尿道做膨出部下缘戳孔术，对单一系统肾发育不良并发异位输尿管膨出的女性，其位置低至尿道远端，因该处尿道肌肉缺损造成失禁，须进一步治疗。     

On the importance of B-scan-ultrasound for the diagnosis of nephrological and urological diseases in childhood (author's transl)]

Kidneys of 118 children of all age groups, and of 2 adults were investigated by means of senography. Normal kidneys could be identified on account of a typical echo-pattern. Deviations from this pattern were interpreted as evidence for pathological changes in the kidneys; they were correlated to the radiological and in some cases to the pathologic-anatomical findings. Typical deviations of the echo-pattern were found in cases of hydronephrosis, duplex kidneys, duplex kidneys in combination with hydronephrosis, polycystic renal diseases and other renal diseases. It was even possible to demonstrate decrease and increase of hydronephrosis by means of sonography. Indications for the application of this method are pointed out. In addition its accuracy and importance in relation to other diagnostics methods are discussed.     

Micturating cystourethrograms are not necessary for all cases of antenatally diagnosed hydronephrosis

ObjectiveSince 1995 we have, at our centre, adopted a selective approach to performing micturating cystourethrograms (MCUGs) on patients with antenatally diagnosed hydronephrosis. This study reviews the outcome of this policy.MethodsWe carry out MCUGs only if any of the following features are present on ultrasound: bilateral hydronephrosis, ureteric dilatation, renal scarring, bladder wall thickness greater than 5 mm, or presence of a duplex system or ureterocele. Patients with simple unilateral hydronephrosis are excluded, and are managed with 6 months’ trimethoprim prophylaxis and ultrasound surveillance with a minimum of 3 years’ follow up.ResultsFifty-five patients were referred with an antenatal diagnosis of hydronephrosis between 1999 and 2002; 26 (47%) did not have an MCUG. Of these, five had increasing hydronephrosis and required surgery for pelvi-ureteric junction obstruction, and three had a multicystic dysplastic kidney on postnatal scanning. In the remaining 18 patients, the hydronephrosis resolved spontaneously, with no renal scars or asymmetry. During follow up, none of these patients had a urinary tract infection.ConclusionWe believe that vesico-ureteric reflux in most antenatally diagnosed hydronephrotic kidneys is physiological rather than pathological, and resolves with time without causing long-term renal damage. This is a separate entity from, rather than a precursor of, the pathological symptomatic refluxing kidney in older, mainly female children. Taking a more conservative approach to the postnatal investigation of antenatally diagnosed hydronephrotic kidneys has not resulted in any missed damaged kidneys, but has reduced the number of invasive investigations performed. A careful protocol and detailed postnatal ultrasonography are important to prevent missed pathological cases.     

Ureteropelvic junction obstruction and calyceal diverticulum in a child with Turner syndrome and horseshoe kidney

Laparoscopic dismembered pyeloplasty for ureteropelvic junction (UPJ) obstruction is considered to be a routine procedure in many pediatric surgical centers. UPJ obstruction is known to be associated with horseshoe kidney and several reports on successful laparoscopic repair in such cases exist.The case of a 9-month-old girl with Turner syndrome is reported. A horseshoe kidney with grade 4 hydronephrosis on the left side was diagnosed by ultrasound during the neonatal period. MAG3 diuretic renography and dynamic magnetic resonance imaging nephrography revealed a differential renal function of 31% and 69% on the left and right side, respectively. No drainage from the left renal pelvis could be demonstrated.Laparoscopy showed a combined UPJ obstruction and a calyceal diverticulum with a narrow infundibulum of the upper pole calices on the left side of the horseshoe kidney. Laparoscopic dismembered pyeloplasty and an additional infundibulopelvic anastomosis was performed. No intraoperative complications occurred. The immediate postoperative course was uneventful. Unobstructed drainage and stable differential renal function on the left side could be demonstrated on MAG3 diuretic renography 6 weeks postoperatively.In conclusion, laparoscopic repair of complex malformations of the upper urinary tract is feasible and leads to good functional outcome in selected cases.     

Incomplete unilateral renal duplication with hydronephrosis and cystic dilatation at confluence of ureters

An extremely rare incomplete duplex system with cystic dilatation of the upper part of the conjoint ureter presenting as hydronephrosis in a 2-year-old infant is reported.     

先天性肾发育不良合并单输尿管异位开口的诊治

目的：报告先天性肾发育不良合并单输尿管异位开口的诊断与治疗。方法：1985年以来对先天性肾发育不良合并单输尿管异位开口女性患儿11例，采用发育不良肾脏及输尿管切除治疗。术前经静脉尿路选影（IVU）、CT、MRI、利尿B超和彩色多普勒超声（CDI）检查。结合手术探查及病理发现对这些检查手段进行评价。结果：本组8例输尿管异位开口于阴道，3例开口于前庭。除1例逆行造影发现肾脏外，IVU，CT，MRI和常规B超仅能发现间接征象。利尿B超检查8,5列发现患肾；CDI检查7例中，5例发现肾脏。结论：先天性肾发育不良合并单输尿管异位开口较为少见，超声检查（处尿B超和彩色多普勒超声）为首选的检查手段，其治疗原则上均应行发育不育肾脏及输尿管切除术。     

Upper pole pelviureteric junction obstruction

A case of neonatal hydronephrosis affecting the upper moiety of a duplex kidney is presented. In addition to the ectopic insertion of the upper-pole ureter into the urethra, the ureter was obstructed by the lower pole at its pelviureteric junction. Accepted: 26 February 1997