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.

The management of lower pole hydronephrosis in duplex urinary system

Objective To review the management of lower pole hydronephnosis in duplex systems in children.Methods Data of three boys and one girl (aged from 6 months to 10 years) with lower pole hydronephnosis in duplex systems admitted into our institution were reviewed.Lower pole dismembered pyeloplasty was performed in one child who had pelvi-ureteric junction obstruction (PUJO) and complete duplex system.Lower pelvis-upper ureterostomy was performed in another child.Lower pole heminephrectomy was performed in one child who had massive hydronephrosis with no function in the lower pole parenchyma,ureterovesical reinplantation was performed in one child who had low pole vesicureteral reflux in Y type.Results Radioisotope scan and voiding cystourethrography at follow-up (mean 12 months) the three patients showed an improvement and no evident of vesicoureteral reflux or functional obstructioa Conclusions Lower pole jydronephnosis in duplex system is a rare condition requiring individualized management.