CAJ | 학술논문

目的总结女性重复肾输尿管及膀胱的诊治体会. 方法女性重复肾输尿管及膀胱患者9例,平均年龄33(26～53)岁.其中重复肾重复输尿管发生在左侧6例、右侧2例、双侧1例.单侧8例重复膀胱为不完全性;双侧重复者1例为完全性重复膀胱,且合并重复尿道、重复子宫及双侧输卵管卵巢,患者重复子宫脱垂Ⅱ度,阴道前壁及重复膀胱膨出.9例均因阴道脱出肿物就诊,经查体、影像学检查并经术中证实诊断8例,1例误诊为阴道壁囊肿者术中确诊.重复肾重度积水无功能者2例行重复肾、重复输尿管全长及重复膀胱切除;重复肾存在分泌功能者7例,行重复膀胱切除、重复输尿管下段膀胱再植术6例;1例完全性重复膀胱合并重复尿道、重复子宫及双侧输卵管卵巢、重复子宫脱垂Ⅱ度、阴道前壁及重复膀胱膨出者行重复膀胱、重复子宫附件及重复尿道切除,重复输尿管下段膀胱再植术. 结果 9例手术均成功,未发生漏尿及输尿管残端综合征.7例输尿管膀胱再植者术后3个月膀胱造影显示输尿管无反流.术后12个月复查IVU,2例重复肾切除者显示患侧残肾形态及功能正常,7例输尿管膀胱再植者显示患侧肾脏及重复肾形态功能良好.合并重复子宫附件者术后1.5年妊娠. 结论影像学检查是诊断重复肾输尿管及膀胱的重要手段.手术是治疗该病的主要方法,术前应重点了解重复肾功能、输尿管形态及走向.手术方式应以解除病痛、保护患肾及重复肾功能、避免感染为原则.
목적 총결녀성중복신수뇨관급방광적진치체회. 방법녀성중복신수뇨관급방광환자9례,평균년령33(26～53)세.기중중복신중복수뇨관발생재좌측6례、우측2례、쌍측1례.단측8례중복방광위불완전성;쌍측중복자1례위완전성중복방광,차합병중복뇨도、중복자궁급쌍측수란관란소,환자중복자궁탈수Ⅱ도,음도전벽급중복방광팽출.9례균인음도탈출종물취진,경사체、영상학검사병경술중증실진단8례,1례오진위음도벽낭종자술중학진.중복신중도적수무공능자2례행중복신、중복수뇨관전장급중복방광절제;중복신존재분비공능자7례,행중복방광절제、중복수뇨관하단방광재식술6례;1례완전성중복방광합병중복뇨도、중복자궁급쌍측수란관란소、중복자궁탈수Ⅱ도、음도전벽급중복방광팽출자행중복방광、중복자궁부건급중복뇨도절제,중복수뇨관하단방광재식술. 결과 9례수술균성공,미발생루뇨급수뇨관잔단종합정.7례수뇨관방광재식자술후3개월방광조영현시수뇨관무반류.술후12개월복사IVU,2례중복신절제자현시환측잔신형태급공능정상,7례수뇨관방광재식자현시환측신장급중복신형태공능량호.합병중복자궁부건자술후1.5년임신. 결론영상학검사시진단중복신수뇨관급방광적중요수단.수술시치료해병적주요방법,술전응중점료해중복신공능、수뇨관형태급주향.수술방식응이해제병통、보호환신급중복신공능、피면감염위원칙.
Objective To report the experiences on the diagnosis and treatment of duplication of kidney ureter and bladder. Methods Nine cases of duplication of kidney ureter and bladder from 1996 to 2008 were reviewed.Six cases of duplicated kidney ureter occurred in the left side and 2 cases in the right side,1 case bilateral kidney ureteral duplication.Of 8 cases with unilateral duplicated,duplicated bladders were incompleteness.And the patient with bilateral duplicated,whose duplicated bladder was completeness,was diagnosed with duplication of urethra,uterine,bilateral ovary and oviduet tubes,and also suffered from duplicated uterine prolapse Ⅱ,vaginal anterior wall bulging and duplicated vesicocele.There were two cases whose duplicated kidney losed function because of severe hydronephrosis,and 7 cases existed kidney secretion function. Excision of duplicated kidney ureter and bladder were performed on 2 cases with non-functional duplicated kidney.6 cases had undergone duplicated bladder excision and duplicated ureteral bladder replantation.The special case had undergone duplicated urinary bladder urethra uterine and bilateral annexes excision,and duplicated ureteral bladder replantation. Results The operation was successful in all paients without leakage and ureter stump syndrome.Three months after operation,ureter bladder imaging showed no ureteral reflux in 7 cases of ureteral bladder replantation.IVU were reviewed 12 months after operation:2 cases undergoing duplicated kidney excision showed that the function of residual kidney were normal,7 cases of replantation that the shape and function of sick side kidney and duplicated kidney were good. The patient who suffered from duplicated uterine simultaneously got pregnancy 1.5 years after operation. Conclsions Image examinations may help to diagnose the duplication of kidney ureter and bladder. The main treatment is surgery. Understanding the function of duplicated kidney and the shape of kidney ureter and bladder should be considered before operation. The goal of surgery should be relieving pain,protecting the function of duplicated kidney and minimizing the risk of infection.