CAJ | 학술논문

目的膀胱输尿管反流(VUR)和肾盂输尿管连接部梗阻(UPJO)这两个最常见的儿童泌尿系统病理状态同时存在较少见.我院近年收治了5例患儿,结合文献,对其诊断及治疗作一探讨.方法收集2011年1月至2012年12月在我院诊治的同时存在单侧VUR及UPJO的5例患儿为研究对象.临扇床上以胎儿肾积水、反复尿路感染及影像检查发现患肾积水或伴肾发育迟缓为特征,表现各异.术前经尿路B型超声、同位素利尿肾图(DR)及排泄性膀胱尿道造影(VCUG)等检查明确诊断.2例患儿同时行UPJO肾盂输尿管成形术和Lich-Gregoir输尿管膀胱再植抗反流手术;1例异时行肾盂输尿管成形术及抗反流手术;1例为腔镜肾盂输尿管成形术后,反流状况在观察中;1例轻度反流单纯肾盂输尿管成形术后半年复查VCUG同侧反流自行消失.结果 5例患儿随访6个月至2年,临床上反复尿路感染症状缓解并消失.复查DR患肾功能稳定、排泄情况有明显改善.结论胎儿或先期发现的UHO是无需常规做VCUG检查的.只有出现反复尿路感染、影像检查输尿管有扩张的以及患肾积水伴肾生长发育迟缓的UPJO必须做VCUG检查.VCUG检查也可提示UPJO存在,同位素利尿肾图可以帮助确定UPJO的存在.治疗的原则是保护肾功能、消除临床症状.高级别VUR合并UPJO符合手术指征的可同时做开放的肾盂输尿管离断成形与输尿管膀胱Lich-Gregoir再植手术;而低级别VUR合并UPJO应先治疗UPJO做肾盂输尿管成形术,反流可以保守治疗,随访观察.对于VUR合并有UPJO的一定需术前明确诊断,如需异时治疗这两个病理状况的则需先行肾盂输尿管成形手术.
목적 방광수뇨관반류(VUR)화신우수뇨관련접부경조(UPJO)저량개최상견적인동비뇨계통병리상태동시존재교소견.아원근년수치료5례환인,결합문헌,대기진단급치료작일탐토.방법 수집2011년1월지2012년12월재아원진치적동시존재단측VUR급UPJO적5례환인위연구대상.림선상상이태인신적수、반복뇨로감염급영상검사발현환신적수혹반신발육지완위특정,표현각이.술전경뇨로B형초성、동위소이뇨신도(DR)급배설성방광뇨도조영(VCUG)등검사명학진단.2례환인동시행UPJO신우수뇨관성형술화Lich-Gregoir수뇨관방광재식항반류수술;1례이시행신우수뇨관성형술급항반류수술;1례위강경신우수뇨관성형술후,반류상황재관찰중;1례경도반류단순신우수뇨관성형술후반년복사VCUG동측반류자행소실.결과 5례환인수방6개월지2년,림상상반복뇨로감염증상완해병소실.복사DR환신공능은정、배설정황유명현개선.결론 태인혹선기발현적UHO시무수상규주VCUG검사적.지유출현반복뇨로감염、영상검사수뇨관유확장적이급환신적수반신생장발육지완적UPJO필수주VCUG검사.VCUG검사야가제시UPJO존재,동위소이뇨신도가이방조학정UPJO적존재.치료적원칙시보호신공능、소제림상증상.고급별VUR합병UPJO부합수술지정적가동시주개방적신우수뇨관리단성형여수뇨관방광Lich-Gregoir재식수술;이저급별VUR합병UPJO응선치료UPJO주신우수뇨관성형술,반류가이보수치료,수방관찰.대우VUR합병유UPJO적일정수술전명학진단,여수이시치료저량개병리상황적칙수선행신우수뇨관성형수술.
Objective To explore the association,treatment options and outcomes of patients with ureteropelvic junction obstruction (UPJO) and concomitant vesicourethral reflux (VUR).Methods We reviewed the clinical records of 5 children with UPJO and concomitant VUR at our hospital between January 2011 and December 2012.Presentations included prenatal hydronephrosis,urinary tract infection (UTI) and renal retardation.The diagnosis of UPJO was based on ultrasonography and diuretic renography.Voiding cystourethrography was performed in all patients to detect vesicourethral reflux.Two patients underwent concomitant pyeloplasty and ureteroneocystostomy (Lich Gr goir repair).One patient underwent heterochronic pyeloplasty plus ureteroneocystostomy.One patient with low-grade VUR had pyeloplasty and the symptoms disappeared 6 months later.And another patient of laparoscopic pyeloplasty was followed up.Results All symptoms improved or disappeared.And renography showed better renal functions and excretion curves.Conclusions The coexistence of UPJO and VUR may be attributable to a single developmental abnormality.And UPJO is probably due to ureteral kinking and inflammation caused by VUR.Voiding cystourethrography is routinely recommended for detecting VUR in children with UPJO.The indications for voiding cystourethrography in children with UPJO should be limited to those with dilated ureters,UTI and renal retardation.High-grade reflux coexisting with UPJO requires pyeloplasty and ureteroneocystostomy.Low-grade reflux coexisting with UPJO may be managed with initial pyeloplasty and subsequent medical observations.