双肾重度积水17例

目的探讨双侧肾盂输尿管连接部梗阻(UPJO)致双肾重度积水的诊断治疗效果。方法回顾总结本院2008年1月-2009年7月诊治的双侧UPJO致双肾重度积水婴幼儿17例14例Ⅰ期行双侧离断式肾盂成形术(Anderson-Hynes术),3例Ⅰ期行单侧离断式肾盂成形术+对侧肾造瘘术、Ⅱ期行对侧离断式肾盂成形术],手术年龄(45±11)d,并于术后3个月、6个月、1 a、2 a行彩超、核素肾显像、尿常规等检查及随访。结果 34侧肾脏术后1例单侧肾出现尿外渗,1例单侧肾出现吻合口狭窄,无出血、切口感染等并发症;末次随访(2a)17例患儿尿常规均正常,彩超提示积水均≤2级,相对肾功能(单侧肾小球滤过率/双侧肾小球滤过率)为(47.30±5.18)%,患儿均未出现肾盂、肾盏分离加大情况,肾皮质厚度逐渐增加,肾功能逐渐恢复。结论确诊存在器质性梗阻的双肾重度积水患儿应尽早手术干预,Ⅰ期双侧离断式肾盂成形术不但疗效确切,且避免了患儿二次手术的痛苦,可作为首选术式;同时应加强术后随访。

Bilateral Severe Hydronephrosis in 17 Infants

Objective To evaluate the diagnosis and treatment of bilateral severe ureteropelvic junction obstruction(UPJO) which leads to bilateral severe hydronephrosis. Methods Seventeen neonates with bilateral severe hydronephrosis who underwent operation(Anderson-Hynes) between Jan.2008 and Jul.2009 were retrospectively analyzed(14 patients underwent single stage bilateral pyeloplasty,the other 3 patients underwent single pyeloplasty and contralateral nephrostomy at the first stage,and contralateral pyeloplasty at the second stage).The average operation age was(45±11)days.The color doppler ultrasound,renal radionuclide imaging and urinalysis were carried out in the 3rd,6th,12th and 24th month after the operation. Results All kidneys recovered well except that one developed urine leak and another developed anastomotic stenosis.In the final follow-up(2 years after operation) urinalysis was normal,the hydronephrosis of each patient was ≤ grade 2,and the relative renal function(unilateral glomerular filtration rate/bilateral glomerular filtration rate) was(47.30±5.18)%.There was no case of renal pelvis and renal calices worse separation,the renal parenchyma thickness gradually increased and the renal function was gradually recovered. Conclusions Once the diagnosis of bilateral severe hydronephrosis is caused by bilateral UPJO,early surgical treatment shall be implemented to prevent the deterioration of renal function.Single stage bilateral pyeloplasty is not only effective but also avoiding the pain of secondary surgery,which shall be received as a safe and preferred surgical program.Postoperative follow-up shall also be strengthened.