双肾积水59例诊治体会

目的　提高各种病因所致双肾积水的诊疗水平。方法　对 5 9例B超诊断的双肾积水患者的诊治经过做回顾性分析总结。结果　 5 6例患者经病因治疗或双侧肾盂引流 ,肾功能得到恢复或不同程度改善 ,1例癌症晚期患者未治疗死亡 ;1例无梗阻 ;1例失访。结论　双肾积水为双侧输尿管或下尿路的机械性或功能性梗阻性病变所致 ,治疗方法为解除梗阻、保护肾功能 ,把握手术适应证及双侧治疗的先后时机尤为重要。对于急性肾后性肾功能衰竭或不能耐受原发病手术的患者 ,首选双侧肾盂穿刺或膀胱镜下双侧输尿管置入D -J管引流 ,可避免透析治疗。     

多排螺旋CT纵剖面重建对输尿管梗阻性疾病的诊断价值

目的探讨多排螺旋CT纵剖面重建对输尿管梗阻性疾病的诊断价值。方法应用Lightspeed16螺旋CT机,对34例输尿管梗阻性病变的病人进行轴位面扫描,并对所得数据进行纵剖面重建。所有病例除2例腹膜后淋巴管转移致输尿管受压外,均经手术病理证实。结果34例患者中,输尿管结石22例,输尿管炎症2例,输尿管癌3例,肾盂输尿管连接处狭窄3例,输尿管囊肿1例,下腔静脉后输尿管1例,腹膜后淋巴结转移压迫输尿管者2例。CT纵剖面重建可显示输尿管腔内结石22处,输尿管管壁增厚者5例。增强扫描的5例病人中,CT值增加约20～35HU,延迟扫描18例表现为轻度积水,6例表现为中度积水,2例表现为重度积水,1例无积水。结论纵剖面重建图像对输尿管梗阻性病变的诊断具有较高的临床应用价值。     

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。     

A New Grading System for the Management of Antenatal Hydronephrosis

Background and objectives

Standard clinical assessments do not predict surgical intervention in patients with a moderate degree of upper tract hydronephrosis. This study investigated whether combined measures of renal calyceal dilation and anteroposterior diameter (APD) of the renal pelvis at the first postnatal ultrasound better predict surgical intervention beyond standard assessments of the APD or Society of Fetal Urology (SFU) grading system.

Design, setting, participants, & measurements

A retrospective cohort of 348 children with antenatal hydronephrosis followed from 2003 to 2013 were studied. Using Cox regression, the risk for surgery by APD, SFU, and combined grading on the basis of the first postnatal ultrasound was calculated. The predictive capability of each grading system for surgery was determined by calculating the positive likelihood ratio (LR+).

Results

The combination of APD≥6–9 mm and diffuse caliectasis had a hazard ratio (HR) of 19.5 (95% confidence interval [95% CI], 3.94 to 96.9) versus 0.59 (95% CI, 0.05 to 6.53) for APD≥6–9 mm alone and a similar risk of 8.9 for SFU grade 3 (95% CI, 3.84 to 20.9). The combination of APD≥9–15 mm and diffuse caliectasis had an HR of 18.7 (95% CI, 4.36 to 80.4) versus 1.75 (95% CI, 0.29 to 10.5) for APD≥9–15 mm alone. The LR+ for surgery for diffuse caliectasis and APD≥6–9 mm was higher than for APD≥6–9 mm alone (HR=2.62; 95% CI, 0.87 to 7.94 versus HR=0.04; 95% CI, 0.01 to 0.32) and was higher for APD≥9–15 mm and diffuse caliectasis than APD≥9–15 mm alone (HR=2.0; 95% CI, 1.15 to 3.45 versus HR=0.14; 95% CI, 0.04 to 0.43). Both combined groups of moderate hydronephrosis (APD≥6–9 mm or ≥9–15 mm with diffuse caliectasis) had only slightly higher LR+ than SFU grade 3 (HR=1.89; 95% CI, 1.17 to 3.05).

Conclusions

These results suggest a grading system combining APD and diffuse caliectasis distinguishes those children with moderate degrees of upper tract hydronephrosis that are at higher risk of surgery.     

Ketamine Abuse-Induced Obstructive Nephropathy and Kidney Injury

KETAMINE is an anaesthetic agent characterized by a rapid onset and short duration of action, but it has increasingly been abused as a ＂clubdrug＂ since the late 1980s. It can causeinflammation and contraction of the bladder, leading to possibly irreversible kidney damage. Since 2007, case reports are appearing in the medical literature describing severe bladder dysfunction and kidney injury in ketamine abusers. In this article, we report a case of obstructive nephropathy and kidney injury in a ketamine abuser.     

赵云芳教授治疗泌尿系病证经验

症见面色萎黄、面目浮肿及肢体浮肿,舌淡红或偏红,苔薄白或黄腻、舌质暗,边有瘀点,患者自述倦怠乏力、便溏,或伴腰膝酸软,腰酸或沉痛,或小腹及会阴胀、隐痛不适,或胁腹疼痛,伴或不伴尿频、尿急、尿痛、尿后余沥不尽,切诊脉弦细或沉弦涩者,皆可应用当归芍药散治疗。     

彩色多普勒超声动态观察大鼠单侧肾积水

目的 :动态观察单侧肾积水对患肾血流动力学的影响并评估患肾功能。方法 :在单侧完全性梗阻的动物模型上 ,用彩色多普勒B超检测梗阻各时期肾血流多普勒参数的动态变化。结果 :积水肾肾血流阻力指数 (RI)值随梗阻时间延长而逐渐升高 ,积水肾肾盂容积 (V)、前后径 (APD)逐渐增大 ,肾皮质厚度 (RCT)逐渐变薄 ,与假手术组比较存在显著性差异 (P <0 .0 5 )。梗阻第 6周开始 ,肾动脉RI值增高明显 ,各组之间比较存在显著性差异 (P<0 .0 1)。梗阻第 6周肾内动脉、第 12周肾动脉血流信号无法检测出。结论 :肾血流动力学改变可反映积水肾的严重程度并可作为临床上评估肾功能的参考指标之一。     

Wilms' tumor in horseshoe kidney: presentation due to ureteropelvic junction obstruction.

Children with horseshoe kidney usually develop urinary tract symptoms and often require operative correction of the anomaly. The incidence of Wilms' tumor in horseshoe kidney is higher than that for the general population. We present the case of a child whose Wilms' tumor was diagnosed early because of ureteropelvic junction obstruction secondary to a horseshoe kidney. A high index of suspicion should be maintained for Wilms' tumor in any child with a horseshoe kidney.     

PELVIURETERIC OBSTRUCTION IN CHILDREN: CONVENTIONAL PYELOPLASTY IS SUPERIOR TO ENDO-UROLOGY

Background : Hydronephrosis secondary to periureteric junction (PUJ) obstruction is common in infancy and childhood. Pyeloplasty has until recently been the accepted method of management, but alternative endo-urological techniques have evolved in the last decade. Methods : Published results of conventional pyeloplasty for primary PUJ obstruction in children were compared with published results of endo-urological procedures. Results : Sixty-six pyeloplasties were performed in 61 children in a 6-year period. During a similar period, 63 primary endo-urological procedures were reported in the literature. The success rate after pyeloplasty was 95.5% compared with 65% after endo-urology. Conclusions : Conventional pyeloplasty is superior to endo-urology and should remain the gold standard for the treatment of primary PUJ obstruction in children.