重复肾合并肾盂输尿管连接部梗阻的诊治特点分析

目的 探讨重复肾畸形合并肾盂输尿管连接部梗阻的诊治特点.方法 1993-2010年共收治肾盂输尿管连接部梗阻患者752例,伴重复肾畸形18例(2.4%).男7例,女11例.平均年龄23(1～47)岁.18例患者均行泌尿系B超检查,15例行泌尿系增强CT检查,11例行IVU检查,10例行逆行造影检查.完全性重复肾畸形3例,不完全性15例;梗阻发生在左侧11例,右侧7例,重复肾肾上极5例,下极13例.结果 18例患者行手术治疗16例,其中肾盂输尿管成形术9例,重复肾半肾切除术7例.术后病理报告示肾盂输尿管连接部肌层结构紊乱,间质内炎症细胞浸润.18例患者平均随访24(6～36)个月.16例手术者症状消失,泌尿系B超及IVU影像学评估肾积水情况明显缓解,SCr水平稳定,肾功能无恶化;2例观察随访者肾积水无加重,肾功能正常.结论重复肾畸形合并肾盂输尿管连接部梗阻临床少见,梗阻多发生于重复肾下极,确诊需结合多种影像学检查手段.膀胱输尿管逆行造影的特异性高,对于疑难病例具有重要意义.手术仍是主要的治疗手段,应根据分肾及半肾功能选择手术方案.

Abstract：

Objective To evaluate the clinical features and treatment of pelvi-ureteric junction obstruction (PUJO) in a duplex kidney. Methods From 1993 to 2010, 752 patients were diagnosed as PUJO in our hospital and 18 patients (2.4%) with PUJO in duplex kidneys. Three patients had obstruction in the complete duplicated systems and 15 in the incomplete duplicated systems. Five patients had obstruction of the upper moiety and 13 of the lower moiety. All of the 18 patients underwent B-ultrasonography, with 15 enhanced CT scan, 11 intravenous urography and 10 retrograde pyelography.All patients had serum creatinine test after admission and during the follow-up. Results Sixteen patients underwent operations and 2 patients were treated conservatively. Nine patients underwent pyeloplasty and 7 patients underwent heminephroureterectomy. Pathology shows derangement of the lamina muscularis at pelvi-ureteric junction and infiltration of inflammatory cells in mesenchymal. They were followed up from 6 months to 3 years with a mean of 24 months. The clinical symptoms of patients who underwent surgery were cured in all cases. B-ultrasound and IVU showed that hydronephrosis was obviously relieved and the levels of serum creatinine remained the same or decreased. The hydronephrosis and serum creatinine of patients who underwent conservative treatment remained stabilized. Conclusions PUJO in duplicated system is a rare condition. Careful preoperative evaluation is needed to reach the final diagnosis and retrograde pyelography has high specificity. Treatment should be individualized according to split and partial renal function.

Clinical features and treatment of pelvi-ureteric junction obstruction in duplex kidney

Objective To evaluate the clinical features and treatment of pelvi-ureteric junction obstruction (PUJO) in a duplex kidney. Methods From 1993 to 2010, 752 patients were diagnosed as PUJO in our hospital and 18 patients (2.4%) with PUJO in duplex kidneys. Three patients had obstruction in the complete duplicated systems and 15 in the incomplete duplicated systems. Five patients had obstruction of the upper moiety and 13 of the lower moiety. All of the 18 patients underwent B-ultrasonography, with 15 enhanced CT scan, 11 intravenous urography and 10 retrograde pyelography.All patients had serum creatinine test after admission and during the follow-up. Results Sixteen patients underwent operations and 2 patients were treated conservatively. Nine patients underwent pyeloplasty and 7 patients underwent heminephroureterectomy. Pathology shows derangement of the lamina muscularis at pelvi-ureteric junction and infiltration of inflammatory cells in mesenchymal. They were followed up from 6 months to 3 years with a mean of 24 months. The clinical symptoms of patients who underwent surgery were cured in all cases. B-ultrasound and IVU showed that hydronephrosis was obviously relieved and the levels of serum creatinine remained the same or decreased. The hydronephrosis and serum creatinine of patients who underwent conservative treatment remained stabilized. Conclusions PUJO in duplicated system is a rare condition. Careful preoperative evaluation is needed to reach the final diagnosis and retrograde pyelography has high specificity. Treatment should be individualized according to split and partial renal function.