重肾双输尿管合并肾盂输尿管交界部梗阻性肾积水的诊治分析

目的 探讨重肾双输尿管合并肾盂输尿管交界部梗阻性肾积水的诊断与处理方法。方法 回顾分析1986～2004年间收治重肾合并肾盂输尿管交界部梗阻肾积水8例的临床资料。男2例，女6例，年龄7个月～10岁，平均4．8岁。病变位于左侧3例，右侧5例；上肾积水2例，下肾积水5例，上下肾积水1例；3例为重肾完全型双输尿管，5例重肾Y型输尿管。结果 3例重肾完全型双输尿管中，上肾积水1例因肾实质薄无功能行上肾切除术，下肾积水伴上肾输尿管膨出症1例行上肾切除下肾离断性肾盂成形术，另1例下肾积水因临床症状轻微，IVP示积水半肾的肾盏变钝不明显，未行手术门诊随诊。5例重肾Y型输尿管中，上肾积水1例行上肾盂与下输尿管吻合，下肾积水3例行上肾输尿管下肾盂吻合 下肾离断性肾盂成形术，1例上下肾均积水行上下肾盂吻合 下肾盂成形术。术后3～6个月复查IVP肾积水明显好转。结论 重肾肾盂输尿管交界部梗阻肾积水发病率很低，术前不容易明确诊断或被误诊。腹部B超、IVP或MRU是有效的辅助检查手段。治疗应根据息肾功能、形态而定，如息肾功能严重受损，行患肾切除，反之，根据积水的部位、输尿管的形态选择手术方式。

Diagnosis and treatment of pyeloureteric junction obstruction in duplex renal systems

Objective To investigate the diagnosis and treatment of pyeloureteric junction obstruction (PUJO) in duplex renal systems.Methods The clinical data of 8 children (male 2 and female 6, age ranged from 7 month to ten years with mean age of 4.8 years ) with PUJO in duplex renal systems between 1986-2004 were retrospectively analysed. Duplex kidneys located at the left side in 3 and 5 in the right. Hydronephrosis was identified in upper moiety in 2, lower moiety in 5, both upper and lower moiety in 1. Three cases had complete duplication of the collecting system while the other 5 had incomplete duplication.Results In 3 cases with complete duplication of the collecting system, 1 patient underwent resection of the upper renal, 1 with resection of the upper renal moiety and lower pyeloureterostomy, the other child without any operation. Of 5 patients with incomplete duplication of the collecting system, 1 child underwent upper pelvis-lower ureterostomy, 3 children with lower pelvis-upper ureterostomy and lower pyeloureterostomy, the other 1 with pelvi-pelvistomy and lower pyeloureterostomy . The hydronephrosis disappeared in all cases within 3-6 moths as identification through intravenous pyelography (IVP) examination.Conclusions The incidence of PUJO in duplex renal systems is very low. B-utrasonography, IVP and MRU are helpful for diagnosis. The operative methods should be decided by the types of lesions.