小儿肾积水548例诊治分析

目的:探讨小儿肾积水的病因、类型及治疗方法。方法:对548例肾积水患儿的临床资料进行分析。结果:548例患儿中,2岁之前发现肾积水或发病476例,2～8岁54例,8岁以上18例;436例给予手术治疗,112例给予保守治疗后,动态观察缓解。436例手术治疗患儿中,423例为肾盂输尿管移行处狭窄,行离断性肾盂成形术;6例为输尿管内息肉梗阻,行输尿管吻合术,2例为肾结石行切开取石术;5例重度肾积水行肾切除。436例中有64例为输尿管多处狭窄,48例为双侧肾积水,4例为孤立肾并肾积水,2例为重复肾并下半肾积水;5例为迷走血管压迫所致。结论:肾盂输尿管移行处狭窄是引起肾积水的主要病因;对于重度肾积水不主张积极行肾切除术;对于轻度肾积水可动态观察。

Diagnosis and management of 548 cases with hydronephrosis in children

Objective： To explore the cause, classification, diagnosis and management of hydronephrosis in children. Methods： Retrospective analysis was done on clinical data of 548 cases hydronephrosis in children. Results： Among 548 cases, 476 cases were under 2 years old, 54 cases among 2-8 years old, 18 cases older than 8 years. 436 patients were done with surgery, and 112 patients relieved without any surgery. Among the cases with surgery, 423 were treated with Anderson-Hynes operation for ureteropelvic junction obstruction; 6 were treated with uretero-ureter anastomosis for ureteral polyps; 2 were treated with lithotomy for renal calculus; 5 were treated with nephrectomy for severe hydronephrosis. Among 436 patients done with surgery, 64 were with multi-stenosis of ureter; 48 were with bilateral hydronephrosis; 4 were with solitary kidney with hydronephrosis; 2 were with duplex kidney with hydronephrosis of inferior part; 5 were with aberration of blood vessels. Conclusion： Ureteropelvic junction obstruction is the mostl common reason of hydronephrosis in Children ; we don＇t positively suggest nephrectomy for every severe hydronephrosis ; dynamic observation is better for light cases.