肾盂输尿管连接部梗阻合并同侧膀胱输尿管连接部梗阻的诊断与治疗

目的 肾盂输尿管连接部梗阻(ureteropelvic junction obstruction,UPJO)和膀胱输尿管连接部梗阻(ureterovesical junction obstruction,UVJO)这两个最常见的儿童泌尿系统病理状态同时存在较少见.本文对单侧UPJO合并同侧UVJO的诊断与治疗进行探讨.方法 回顾性分析上海交通大学医学院附属新华医院2012年1月至2015年7月间手术治疗的UPJO合并UVJO患儿.术前常规行泌尿系超声、同位素利尿肾图(DR)及排泄性膀胱尿道造影(VCUG)等检查.结果 我院共诊治单侧UPJO合并UVJO的43例患儿,失访2例.11例患儿术前明确诊断;41例患儿先行肾盂成形术+肾造瘘术,其中10例术后复查发现输尿管末端狭窄自行缓解,28例再次接受输尿管膀胱再植术,3例患儿行肾盂成形术+肾造瘘术后复查核素提示分肾功能低于10％,给予患肾切除;38例患儿术复查肾积水程度和肾脏功能均得到显著改善.结论 单侧UPJO合并UVJO的术前诊断非常困难,术中应仔细检查,避免遗漏同时合并存在的病理改变.术前尽量通过超声、DR及MR等影像检查作出明确诊断,进而制定个体化的治疗方案,能够获得满意的治疗效果.如术前明确有UPJO的存在,应选择首先进行肾盂成形术,术后根据检查结果决定是否行输尿管膀胱再植术.

Diagnosis and management of concurrent ureteropelvic and ureterovesical junction obstructions in children

Objective To report our experience of diagnosing and treating coexisting ureteropelvic junction obstruction (UPJO) & ureterovesical junction obstruction (UVJO) in pediatric patients.Methods We searched for pediatric patients with coexisting UPJO & UVJO between January 2012 to July 2015.Ultrasonography,diuretic renography and voiding cystourethrography were performed preoperatively.Results There were 43 pediatric patients with coexisting UPJO & UVJO.Two patients were lost to follow-up.The correct diagnosis was made preoperatively in 11 patients.Pyeloplasty was the initial surgical option for 41 patients.Among 41 patients undergoing initial pyeloplasty,additional ureteroneocystostomy was required in 28.Renal function of 3 cases was less than 5％ after initial pyeloplasty and renal resection performed.Function and morphology of hydronephrotic kidneys were restored significantly in other patients.Conclusions It is often difficult to correctly diagnose coexisting UPJO and UVJO.Examinations should be carefully checked to avoid the omission of coexisting pathological changes.A definite diagnosis should be made through necessary preoperative imaging examinations.Then satisfactory outcomes may be obtained by individualized treatment plan.Initial pyeloplasty should be chosen if there is a clear diagnosis of UPJO before operation.Ureteroneocystostomy should be performed according to the results of examination.