Anderson-Hynes离断性肾盂成形术治疗新生儿肾盂、输尿管连接部梗阻疗效观察

doi:10.3877/cma.j.issn.1673-5250.2011.04.017

目的

评价Anderson-Hynes离断性肾盂成形术(Anderson-Hynes disarticulation of pyeloplasty)治疗新生儿期肾盂、输尿管连接部梗阻(ureteropelvic junction obstruction, UPJO)的疗效。

方法

选取2005年1月至2010年12月于本院诊断为新生儿期肾盂、输尿管连接部梗阻致患侧重度肾积水，而行Anderson-Hynes离断性肾盂成形术治疗的10例新生儿为研究对象。纳入标准：产前超声诊断结果示胎儿患侧重度肾积水，生后超声检查结果示患侧肾影增大，并重度肾积水，肾盂分离值为(2.6~5.7)cm，肾皮质厚度为(2~7)mm；增强CT及三维重建尿路成像(three-dimensional imaging of urinary tract)结果示患侧输尿管不显影，患侧肾显影明显延迟，肾盂重度积水；单光子发射计算体层摄影(single photon emission computed tomography，SPECT)结果示，患侧肾功能<35%；血肌苷、尿素氮结果均正常。Anderson-Hynes离断性肾盂成形术后约5 d拔除肾周引流管，术后10 d拔除输尿管支架管。术后2周经肾造瘘管X射线造影显示肾盂、输尿管吻合口通畅，将肾造瘘管夹闭24 h，若无异常，则将其拔除。术后定期复查肾脏超声(本研究遵循的程序符合本院人体试验委员会所制定的伦理学标准，得到该委员会批准，征得受试对象监护人的知情同意，并与之签署临床研究知情同意书)。

结果

10例患儿手术均成功。患侧肾盂前、后径值逐渐减小，肾皮质增厚，肾盂、输尿管连接部吻合口通畅。复查血肌苷、尿素氮均正常。

结论

新生儿肾盂、输尿管连接部梗阻致患侧重度肾积水宜尽早手术治疗。Anderson-Hynes离断性肾盂成形术是治疗新生儿肾盂、输尿管连接部梗阻的有效方法之一。

关键词: 肾盂、输尿管连接部梗阻, Anderson-Hynes离断性肾盂成形术, 新生儿

Objective

To evaluate the effect of Anderson-Hynes disarticulation of pyeloplasty in neonatal ureteropelvic junction obstruction.

Methods

From January 2005 to December 2010, 10 neonatal cases with ureteropelvic junction obstruction(UPJO) were treated with Anderson-Hynes disarticulation of pyeloplasty. The perinephric drainage tubes were removed after approximately 5 days of operation.The ureteral catheters were removed after 10 days. The nephrostomy tubes were removed when they were showed through by urography after 2 weeks. They were checked by renal ultrasound at regular intervals. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Hubei Women and Children's Hospital. Informed consent was obtained from all participants.

Results

Successful rate of operation was 100%. The diameter of renal pelvis was reduced gradually after operation. The thickness of renal cortex was better gradually after operation. The ureteropelvic junction obstruction was dissolved successfully during follow-up of 6 months after operation.

Conclusion

The vital hydronephrosis by neonatal ureteropelvic junction obstruction should be operated as soon as possibly. The effect of Anderson-Hynes pyeloplasty in neonatal ureteropelvic junction obstruction is satisfied.

Key words: ureteropelvic junction obstruction(UPJO), Anderson-Hynes disarticulation of pyeloplasty, neonate

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Effects of Anderson-Hynes Disarticulation of Pyeloplasty in Neonatal Ureteropelvic Junction Obstruction

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Effects of Anderson-Hynes Disarticulation of Pyeloplasty in Neonatal Ureteropelvic Junction Obstruction