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成人先天性巨输尿管症30例报告 |
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李晓飞 郑克立 梅骅 曾金云 戴宇平 丘少鹏 陈凌武
摘 要：目的：探讨成人先天性巨输尿管症的诊治方法。方法：报告30例成人先天性巨输尿管症，其中左侧18例，右侧7例，双侧5例。30例中行肾输尿管切除术2例；行输尿管膀胱吻合术28例，其中先行肾造瘘术，二期行输尿管膀胱吻合术5例。结果：28例输尿管膀胱吻合术中，成功26例，成功率92.9%。结论：对静脉肾盂造影不显影的患肾应行同位素肾动态显像，以决定手术方案。治疗本症的原则是解除梗阻，尽量保留肾功能。理想的手术方式是输尿管裁剪加输尿管膀胱吻合术。
关键词：先天性巨输尿管 输尿管膀胱吻合术
Congenital megaureter in adults (Report of 30 cases)
LI Xiao-fei ZHENG Ke-li MEI Hua ZENG Jin-yun DAI Yu-ping QIU Shao-peng CHEN Lin-wu
(Department of Urology,the First Affiliated Hospital,Sun Yat-sen University of Medicine Science,Guangzhou，510080)
Abstract：Purpose：To explore the methods of dignosis and treatment for the megaureter in adults. Methods：Thirty cases with megaureter in adults were presented. The anomaly was on left side in 18 cases, on the right side in 7 and bilateral in 5.2 of 30 cases were treated by total renoureterectomy, 28 cases by ureteric cystostomy, 5 in 28 cases by one-stage with nephrostomy and then two-stage with ureteric cystostomy.Results：26 of 28 cases with ureteric cystostomy were successful. The total success rate was 92.9%.Conclusions：Nuclei renal dynamic scintigraphy is necessary to decide the pattern of sugery for the cases with no kidney function expressed by intravenous pyelograms. The principle of treatment for the disease is to relief obstruction and conserve the function of kidney. The most effective operative pattern is to clip dilated ureter and anastomose the ureter and cyst.
Key words：Congenital megaureter Ureterovesical anastomosis▲
成人先天性巨输尿管症临床并不多见，我院自1980～1998年共收治30例，现报告如下。
1 资料与方法
1.1 临床资料
本组30例中，男3例，女27例。年龄18～60岁，平均34.04岁。左侧18例，右侧7例，双侧5例。临床症状：患侧腰痛25例，血尿12例，尿频、尿急6例，上腹部包块2例，头痛、头昏伴高血压1例。尿常规：白细胞＋～15例，红细胞＋～12例；血清肌酐(SCr)、尿素氮(BUN)升高1例。静脉肾盂造影检查：患肾中度积水23例，其中双侧4例，患肾不显影6例，并发输尿管结石5例。B超检查均显示中～重度肾积水影像。逆行肾盂造影：30例输尿管可顺利通过F5导管，均表现患肾积水，输尿管扩张，下段输尿管呈鸟嘴状改变。同位素肾动态显像检查18例，呈极重度损害1例，中～重度损害4例，轻～中度损害13例，轻～中度损害者利尿肾图均有梗阻表现。
1.2 治疗方法
肾输尿管切除术2例[1] [2] 下一页
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