CAJ | 학술논문

目的提高儿童外伤性肾盂输尿管连接部(Pelvi-Ureteric Junction,PUJ)断裂的诊治水平.方法回顾分析1993年至2014年收治的31例PUJ断裂患儿的临床资料,男23例,女8例,年龄1岁5个月至10岁7个月,平均6岁3个月,右侧18例,左侧13例.车祸伤30例,刀扎伤1例.首诊在我院的有5例,诊断PUJ断裂为伤后5～20 d(平均12.5 d).转入我院26例,诊断PUJ断裂在伤后8个月、10个月各1例,其余24例转入患儿诊断为PUJ断裂在伤后20～90 d,平均42 d.肾盂输尿管吻合21例,肾下盏与输尿管吻合5例,回肠代输尿管2例,阑尾代输尿管1例.肾切除2例.结果 29例行输尿管修复手术中,术后2～3周顺利拔出肾造瘘管13例,延期拔除肾造瘘管13例,因吻合口闭锁再次行肾盂输尿管吻合治愈3例,术后半年复查静脉肾盂造影肾功能良好25例,1例仅肾下极显影,3例患肾显影差.2例肾切除者肾功能正常.结论 PUJ断裂多合并其他外伤,往往延误诊断,有无血尿不是PUJ断裂的指征,增强CT延迟摄片有利于PUJ断裂的检出,输尿管逆行造影是确诊依据,一旦确诊尽量行输尿管修复手术,如条件所限不能做修复手术可做肾造瘘,不能仅做肾周尿囊造瘘.
목적 제고인동외상성신우수뇨관련접부(Pelvi-Ureteric Junction,PUJ)단렬적진치수평.방법 회고분석1993년지2014년수치적31례PUJ단렬환인적림상자료,남23례,녀8례,년령1세5개월지10세7개월,평균6세3개월,우측18례,좌측13례.차화상30례,도찰상1례.수진재아원적유5례,진단PUJ단렬위상후5～20 d(평균12.5 d).전입아원26례,진단PUJ단렬재상후8개월、10개월각1례,기여24례전입환인진단위PUJ단렬재상후20～90 d,평균42 d.신우수뇨관문합21례,신하잔여수뇨관문합5례,회장대수뇨관2례,란미대수뇨관1례.신절제2례.결과 29례행수뇨관수복수술중,술후2～3주순리발출신조루관13례,연기발제신조루관13례,인문합구폐쇄재차행신우수뇨관문합치유3례,술후반년복사정맥신우조영신공능량호25례,1례부신하겁현영,3례환신현영차.2례신절제자신공능정상.결론 PUJ단렬다합병기타외상,왕왕연오진단,유무혈뇨불시PUJ단렬적지정,증강CT연지섭편유리우PUJ단렬적검출,수뇨관역행조영시학진의거,일단학진진량행수뇨관수복수술,여조건소한불능주수복수술가주신조루,불능부주신주뇨낭조루.
Objective To improve the diagnosis and treatment of traumatic pelvi-ureteric junction (PUJ)disruption in children.Methods A retrospective study was conducted for a total of 31 patients with traumatic PUJ disruption from 1993 to 2014.Their clinical records were reviewed for mechanism of injury,diagnostics and treatment.Results There were 23 males and 8 females with a mean age of 6.25 (1.5-10.5) years.The lesions were right (n=18) and left (n=5).And the causes were traffic accident (n =30) and penetrating injury (n =1).For 5 cases of initially presenting at our hospital,the mean interval from trauma to diagnosis was 12.5 (5-20) days.For the remainder transferred to our hospital beyond 24 h,the mean interval from trauma to diagnosis was 42(20-90) days.Pelvi-ureteric reanastomosis and caliceal ureterostomy were performed for 21 and 5 patients respectively.And ileal and appendix replacement for ureteral injuries were finally performed for 2 and 1 patient respectively.Two patients underwent nephrectomy.Hydronephrosis of injured kidney lessened and function improved in 25 patients.Conclusions PUJ disruptions are uncommon and more likely to have a delayed diagnosis because of associated injuries.Haematuria is not indicative of ureteral trauma in children.Computed tomography (CT) with delayed excretory phase imaging may aid its diagnosis.And a definite diagnosis is made by retrograde pyelography under anesthesia.Definitive ureteral reconstruction is preferred with pelvi-ureteric reanastomosis or nephrostomy.Drainage of circumrenal urinoma and nephrectomy should be avoided.