重复肾输尿管畸形的大体病理特点及腹腔镜手术治疗

目的总结重复肾输尿管畸形的大体病理特点及其腹腔镜手术治疗的经验。方法对近5年来治疗的38例重复肾输尿管畸形，据术中所见重复肾输尿管的形态、位置、大小、扩张程度、与正常下肾的连接关系及两者间分界线等病理特点，将重复肾输尿管畸形分为5种类型。总结各型在行腹腔镜手术时的注意事项及并发症。结果38例重复肾输尿管畸形中，经后腹腔镜手术治疗35例，成功33例，占94．3％，手术时间平均1h，术中出血平均5～10ml，术后平均4d出院。随访3个月～5年，正常下肾未见异常。术中误轻伤下肾中转开腹1例，行下半肾上极部分切除，术后7d出院。误轻伤下肾上极血管致下肾上1／3肾颜色变暗1例，术后随访1年，未见肾萎缩。经膀胱输尿管再植手术成功治疗3例。发现重复肾大体病理可分为5型，分型有助于手术治疗。结论经后腹腔镜可较好地完成重复肾输尿管切除术，与传统开放手术相比，具有创伤小、术后恢复快、瘢痕小等特点。将重复肾分型对手术治疗有帮助。

The importance of pathologic classification on laparoscopic management for children with renal duplication

Objective To explore the relationship between pathologic classification and the results of laparoscopic management for children with renal duplication. Methods Thirty-eight children with renal duplication were hospitalized in our institute during last 5 years. The renal duplication could be classified into 5 types based on the characteristics of ureteral duplication in shape, mocation, size, and distension, and the boundary between the upper and lower kidney. The details of laparoscopic procedure and its complications were summarized. Results Out of 38 cases with renal duplication, 35 cases underwent retroperitoneal laparoscopic upper pole nephrectomy, and 33 cases ( 94.3%) were successfully managed. The mean time of laparoscopic procedure was 1 hour, the volume of bleeding was 5 to 10 ml, and the mean duration of hospitalization was 4 days. No abnormal findings could be noted on the lower kidney during follow-up term of 3 months to 5 years. The other 3 cases were successfully treated by ureteral reimplantation. Conclusions Pathologic classification is helpful for treatment of renal duplication in children.