CAJ | 학술논문

目的探讨重复肾畸形合并肾盂输尿管连接部梗阻的诊治特点.方法 1993-2010年共收治肾盂输尿管连接部梗阻患者752例,伴重复肾畸形18例(2.4%).男7例,女11例.平均年龄23(1～47)岁.18例患者均行泌尿系B超检查,15例行泌尿系增强CT检查,11例行IVU检查,10例行逆行造影检查.完全性重复肾畸形3例,不完全性15例;梗阻发生在左侧11例,右侧7例,重复肾肾上极5例,下极13例.结果 18例患者行手术治疗16例,其中肾盂输尿管成形术9例,重复肾半肾切除术7例.术后病理报告示肾盂输尿管连接部肌层结构紊乱,间质内炎症细胞浸润.18例患者平均随访24(6～36)个月.16例手术者症状消失,泌尿系B超及IVU影像学评估肾积水情况明显缓解,SCr水平稳定,肾功能无恶化;2例观察随访者肾积水无加重,肾功能正常.结论重复肾畸形合并肾盂输尿管连接部梗阻临床少见,梗阻多发生于重复肾下极,确诊需结合多种影像学检查手段.膀胱输尿管逆行造影的特异性高,对于疑难病例具有重要意义.手术仍是主要的治疗手段,应根据分肾及半肾功能选择手术方案.
목적 탐토중복신기형합병신우수뇨관련접부경조적진치특점.방법 1993-2010년공수치신우수뇨관련접부경조환자752례,반중복신기형18례(2.4%).남7례,녀11례.평균년령23(1～47)세.18례환자균행비뇨계B초검사,15례행비뇨계증강CT검사,11례행IVU검사,10례행역행조영검사.완전성중복신기형3례,불완전성15례;경조발생재좌측11례,우측7례,중복신신상겁5례,하겁13례.결과 18례환자행수술치료16례,기중신우수뇨관성형술9례,중복신반신절제술7례.술후병리보고시신우수뇨관련접부기층결구문란,간질내염증세포침윤.18례환자평균수방24(6～36)개월.16례수술자증상소실,비뇨계B초급IVU영상학평고신적수정황명현완해,SCr수평은정,신공능무악화;2례관찰수방자신적수무가중,신공능정상.결론중복신기형합병신우수뇨관련접부경조림상소견,경조다발생우중복신하겁,학진수결합다충영상학검사수단.방광수뇨관역행조영적특이성고,대우의난병례구유중요의의.수술잉시주요적치료수단,응근거분신급반신공능선택수술방안.
Objective To evaluate the clinical features and treatment of pelvi-ureteric junction obstruction (PUJO) in a duplex kidney. Methods From 1993 to 2010, 752 patients were diagnosed as PUJO in our hospital and 18 patients (2.4%) with PUJO in duplex kidneys. Three patients had obstruction in the complete duplicated systems and 15 in the incomplete duplicated systems. Five patients had obstruction of the upper moiety and 13 of the lower moiety. All of the 18 patients underwent B-ultrasonography, with 15 enhanced CT scan, 11 intravenous urography and 10 retrograde pyelography.All patients had serum creatinine test after admission and during the follow-up. Results Sixteen patients underwent operations and 2 patients were treated conservatively. Nine patients underwent pyeloplasty and 7 patients underwent heminephroureterectomy. Pathology shows derangement of the lamina muscularis at pelvi-ureteric junction and infiltration of inflammatory cells in mesenchymal. They were followed up from 6 months to 3 years with a mean of 24 months. The clinical symptoms of patients who underwent surgery were cured in all cases. B-ultrasound and IVU showed that hydronephrosis was obviously relieved and the levels of serum creatinine remained the same or decreased. The hydronephrosis and serum creatinine of patients who underwent conservative treatment remained stabilized. Conclusions PUJO in duplicated system is a rare condition. Careful preoperative evaluation is needed to reach the final diagnosis and retrograde pyelography has high specificity. Treatment should be individualized according to split and partial renal function.