肾盂输尿管连接部梗阻的开放手术治疗

目的 探讨肾盂输尿管连接部梗阻(UPJO)的临床特点和诊治方法.方法 UPJO患者222例.男155例,女67例.平均年龄29(13～75)岁.病程6个月～4.5年,平均27个月.临床表现为腰腹部胀痛173例、尿路感染19例、腹部包块12例、肉眼血尿7例,体检B超检查发现11例.其中肾盂输尿管连接部狭窄185例、肾盂输尿管高位连接18例、纤维条索或迷走血管压迫19例.患者均行B超检查,提示不同程度肾积水;IVU检查215例,其中肾积水轻度29例、中度115例、重度61例,患肾不显影10例;逆行肾盂造影检查37例及CT尿路造影检查19例,均提示肾盂输尿管连接部狭窄.222例均手术,其中离断性肾盂成形术191例、纤维条索或迷走血管切断19例、患肾无功能行肾切除12例.结果 191例行离断性肾盂成形术者随访6个月～8年,平均38个月,B超及IVU检查提示患侧肾实质明显增厚,尿路通畅.肾积水完全消失127例,轻度肾积水58例、中度积水6例;患者腰腹胀痛,腹部包块,尿路感染及肉眼血尿症状消失;7例术前SCr为146～203μmol/L者术后复查均<133μmol/L.结论 离断性肾盂成形术为UPJO病例的标准术式,疗效确切.

Operative treatment for ureteropelvic junction obstruction

Objective To analyze the clinical features and summarize diagnosis and therapeutic efficacy for ureteropelvic junction obstruction(UPJO). Methods Two hundred and twenty-two patients with UPJO were treated from 2000 to 2008,including 155 males and 67 females:the age rangeed from 13 to 75 and mean age was 29 years.One hundred and seventy-three cases presented with back pain;19 cases with urine infection;12 cases with abdomen bump;7 cases with macroscopic hematuria;11 cases found by B-ultrasound examine.Etiological factors included 185 patients of ureteropelvic junction stenosis;18 cases of high location of the junction;19 cases which were diagnosed UPJO due to benign oppression,including fiber cords and peculiar vessels.A total of 222 cases of surgical procedures were conducted,of them Anderson-Hynes dismembered pyeloplasty was conducted for 191 cases,fiber cords and peculiar vessels were relieved for 19,nephrectomy for 12 cases because of nonfunction. Results One hundred and ninety-one cases who underwent Anderson-Hynes dismembered pyeloplasty were all succeeded with operation.They were followed up for 6 months to 8years with a mean of 38 months.B-ultrasound and IVU showed that hydronephrosis was obviously relieved.The clinical symptoms disappeared in all cases.The levels of serum creatinine of 7 cases who had higher ereatinine recovered. Conclusion Anderson-Hynes dismembered pyeloplasty could be a good choice and effective method for the treatment of UPJO.