CAJ | 학술논문

目的：探讨输尿管镜钬激光治疗儿童输尿管末端囊肿的疗效。方法回顾性分析2010年3月至2014年3月本院22例儿童输尿管末端囊肿临床资料，均经B 超、泌尿系CT、静脉尿路造影、膀胱逆行造影检查确诊，并接受输尿管镜钬激光囊肿切开术。22例患儿年龄3个月至15岁，平均3．6岁，其中女性15例（68．2％），男性7例（31．8％）；左侧9例（40．9％），右侧11例（50．0％），双侧2例（9．1％）；囊肿开口于膀胱内20例（90．9％），开口于膀胱颈尿道内口2例（9．1％）；16例（72．7％）合并患侧肾积水或者输尿管扩张，7例（31．8％）合并重复肾畸形，且均为上下位肾输尿管Y形融合并以末端囊肿开口于膀胱内，4例（18．2％）伴有膀胱输尿管反流，1例（4．5％）合并输尿管末端结石，13例（59.1％）合并尿路感染；均行输尿管镜钬激光囊肿切开术，手术时间为14～46 min，平均（28±10）min，术中出血量2～10 mL，住院时间2～5 d，平均（3．1±1．0）d。结果术后21例随访，1例失访，随访时间为3～31个月，20例未见输尿管囊肿复发，10例尿路感染症状完全消失，12例肾积水或者输尿管扩张得到明显改善，1例合并结石的未见复发，1例出现膀胱输尿管反流加重而行输尿管膀胱再植术。结论输尿管镜钬激光治疗儿童输尿管末端囊肿操作简便，创伤小，手术时间短，恢复快，并发症少，可作为首选治疗方式；对于严重膀胱输尿管反流，异位输尿管开口的重复肾患儿，术前需要做充分评估，以减少再次手术的风险。
목적：탐토수뇨관경화격광치료인동수뇨관말단낭종적료효。방법회고성분석2010년3월지2014년3월본원22례인동수뇨관말단낭종림상자료，균경B 초、비뇨계CT、정맥뇨로조영、방광역행조영검사학진，병접수수뇨관경화격광낭종절개술。22례환인년령3개월지15세，평균3．6세，기중녀성15례（68．2％），남성7례（31．8％）；좌측9례（40．9％），우측11례（50．0％），쌍측2례（9．1％）；낭종개구우방광내20례（90．9％），개구우방광경뇨도내구2례（9．1％）；16례（72．7％）합병환측신적수혹자수뇨관확장，7례（31．8％）합병중복신기형，차균위상하위신수뇨관Y형융합병이말단낭종개구우방광내，4례（18．2％）반유방광수뇨관반류，1례（4．5％）합병수뇨관말단결석，13례（59.1％）합병뇨로감염；균행수뇨관경화격광낭종절개술，수술시간위14～46 min，평균（28±10）min，술중출혈량2～10 mL，주원시간2～5 d，평균（3．1±1．0）d。결과술후21례수방，1례실방，수방시간위3～31개월，20례미견수뇨관낭종복발，10례뇨로감염증상완전소실，12례신적수혹자수뇨관확장득도명현개선，1례합병결석적미견복발，1례출현방광수뇨관반류가중이행수뇨관방광재식술。결론수뇨관경화격광치료인동수뇨관말단낭종조작간편，창상소，수술시간단，회복쾌，병발증소，가작위수선치료방식；대우엄중방광수뇨관반류，이위수뇨관개구적중복신환인，술전수요주충분평고，이감소재차수술적풍험。
Objetive To evaluate the effect of ureteroscopic holmium laser treat the ureter cyst of chil-dren. Methods The clinical data of 22 cases of ureter cyst patients for children from March 201 0 to March 201 4 were analyzed retrospectively.These patients are receive ultrasound,urinary tract CT,Intravenous urina-ry tract imaging examination,Bladder retrograde urethrography before diagnosis of ureter cyst,and then accept the operation of ureteroscopy holmium laser incision.The age of 22 cases from 3 months to 1 5 years old,which girl 15 cases (68.2%)and boy 7 cases (31.8%);9 cases (40.9%)on the left side of,11 cases (50.0%) on the right side,and 2 cases (9.1%)with double side;20 cases (90.9%)of cyst open in the bladder,2 ca-ses(9.1%)of cyst open in the bladder neck of internal urethral orifice;16 cases (72.7%)of hydronephrosis or ureterectasia;7 cases (31 .8%)patients with duplex kidney,both these ureter of duplex kidney are com-bined with Y shape and last opening in the bladder for the end of ureter cyst;4 cases (18.2%)with Vesi-coureteral reflux,1 case (4.5%)complicated stone,13 cases (59.1%)children with urinary tract infec-tions.All patients received the operation of ureteroscopy holmium laser incision.Operative time was 1 4~46 min,average 28 ±1 0 min,blood loss was about 2~1 0 mL,hospitalization time was 2 to 5 days,with an aver-age was 3.1 ±1 .0 days. Results 21 cases were followed after surgery,one patient was lost,follow-up period from 3 to 31 months.The followed children were review ultrasound and urine routine examination.20 cases without recurrence of ureterocele,1 0 cases of children the symptoms of recurrent urinary tract infection com-pletely disappeared,1 2 patients with hydronephrosis or ureterectasia has been significantly improved,and 1 case combined stone without recurrence after operation,One patient perform ureteral reimplantation because of severe vesicoureteral reflux. Conclusion Holmium laser treatment for children ureterocele has many advanta-ges:easy to operate,small trauma,shorten operation time,accelerate postoperative recovery ,reduce complica-tions,can be used as the first treatment.But for the children of severe vesicoureteral reflux or ectopic ureter o-pening of duplex kidney,the risk assessment need to be fully preoperatively before surgery in order to reduce the risk of reoperation.