小儿先天性输尿管中段梗阻诊疗分析

张岗1，杨增雷1 ，郭涛2 ，白安胜1 ，徐泉1

（1.西北妇女儿童医院小儿外科，陕西 西安，710061；2.西安市儿童医院泌尿外科，陕西 西安，710003）

浏览次数：70次 下载次数：312次

摘要：

目的 探讨小儿先天性输尿管中段梗阻的诊疗方法及疗效。方法 选取2009年1月至2015年3月收治的20例先天性输尿管中段梗阻患儿为研究对象，所有患儿术前行相应检查包括B超、CT及逆行性输尿管造影检查。采用下腹部小切口，经腹膜外切除病变段输尿管，行端端吻合术，留置输尿管支架管。术中观察梗阻病因，术后3 月复查尿常规并观察伤口外观。术后3、6、9月复查B超，比较肾盂、输尿管扩张及肾皮质厚度变化情况。结果 所有患儿手术均顺利，无并发症发生。术中明确梗阻病因，15例为输尿管狭窄，3例为输尿管内瓣膜，2例为迷走血管压迫。术后4周顺利拔除输尿管支架管。随访3～9 月，尿常规正常，伤口愈合好，外观满意。B 超复查肾积水及输尿管扩张均明显缓解，肾皮质厚度增加。结论 小儿先天性输尿管中段梗阻较少见，采用下腹部小切口入路手术可取得满意手术疗效，术后外观满意。

关键词：输尿管中段梗阻；端端吻合术；小切口

中图分类号：R726.9文献标志码：A文章编号：2096-1413(2017)08-0109-02

Diagnosis and treatment analysis on children with congenital middle segment obstruction of ureter
ZHANG Gang 1, YANG Zeng-lei 1, GUO Tao 2, BAI An-sheng 1, XU Quan 1
（1. Department of Pediatric Surgery, Northwest Women`s and Children`s Hospital, Xi`an 710061; 2. Department of Urology Surgery,
Xi`an Children`s Hospital, Xi`an 710003, China）

ABSTRACT：Objective To investigate the diagnosis and treatment method and curative effect of congenital middle segment obstruction of ureter in children. Methods Twenty cases of children with congenital middle segment obstruction of ureter admitted in our hospital from January 2009 to March 2015 were selected as the study objects. All the children received corresponding preoperative examination including B ultrasound, CT and retrograde ureteropyelography. The operation was implemented through a small incision in the lower abdomen, and the ureteral lesion was removed, then performed end-to-end anastomosis, and the double J catheter was placed during operation. The causes of obstruction were observed during operation, and the routine urine and the wound appearance were observed 3 months after operation. B-ultrasound was performed 3, 6 and 9 months after operation, and the renal pelvic and dilatation of ureter and renal cortical thickness were compared. Results The operations of the children were successful without any complications. The causes of obstruction were defined in the operation, 15 cases were ureteral stricture, 3 cases were ureteral valve, 2 cases were lost blood vessel compression. The double J catheter was removed in 4 weeks, after followed-up for 3~9 months, the routine urinalysis was normal, and wound appearance was satisfactory. B -ultrasound showed that the hydronephrosis and ureterectasis relieved, and renocortical thickness increased. Conclusion The congenital middle segment obstruction of ureter in children is rare, and operation through a small incision in the lower abdomen has significant surgical curative effect and wound appearance is satisfactory.
KEYWORDS: middle segment obstruction of ureter；end-to-end anastomosis; small incision

参考文献：
[1] HHWANG AH,MCALEER IM,SHAPIRO E,et al.Congenital mid ureteral strictures[J].J Urol,2005,174(5):1999-2002.
[2] RABINOWITZ R,KINGSTON TE,WESSELHOEFT C,et al.Ureteral valves in children[J].Urology,1998,51(5):7-11.
[3] CAUCHI JA,CHANDRAN H.Congenital ureteric strictures: an uncommon cause of antenatally detected hydronephrosis[J].Pediatr Surg Int, 2005,21(7):566-568.
[4] 梅骅.泌尿外科手术学[M].2 版.北京:人民卫生出版社.1996:207-209.


[5] 郭应禄,周立群.坎贝尔-沃尔什泌尿外科学[M].9 版.北京:北京大 学医学出版社,2009:3602-3663.