摘要
目的探讨小儿单侧肾发育不良的临床特点及诊断方法,评价腹腔镜治疗小儿单侧肾发育不良的价值和疗效。方法 2004年12月-2009年3月因单侧肾发育不良在本院经腹腔镜行肾及部分输尿管切除术的患儿9例。男3例,女6例;平均年龄5.2岁（2.5~10.0岁）。4例并输尿管开口异位,1例并泌尿系统感染。术前常规行多普勒超声、静脉肾盂造影（IVP）、IVP后延迟CT扫描三维重建和99Tcm-二乙烯三胺五乙酸（DTPA）核素扫描检查。结果超声探及肾发育不良6例。其中探及盆腔扩张输尿管1例;IVP检查均未显示肾发育不良;IVP后延迟CT扫描三维重建显示所有肾发育不良;99Tcm-DTPA核素扫描4例可见肾脏显影,5例在盆腔显示输尿管影像。腹腔镜找到了所有肾发育不良,平均手术时间75 min（61~162 min）,术后所有患儿恢复平稳,尿淋漓消失,泌尿系统感染治愈。术中、术后无并发症发生,术后平均4.2 d（3~5 d）出院。随访3个月~5 a,患儿均恢复良好,排尿正常。结论腹腔镜治疗肾发育不良安全有效,即使术前影像学检查不能定位肾脏,腹腔镜也能成功切除患肾和输尿管。
Objective To explore the clinical features and management of 9 cases with unilateral dysplastic kidney and assess the value and curative effect of laparoscopic nephroureterectomy for unilateral dysplastic kidney in children.Methods From Dec.2004 to Mar.2009,laparoscopic nephroureterectomy was performed in 9 children（3 boys,6 girls） with unilateral dysplastic kidney.The average age was 5.2 years old（ranged from 2.5 to 10.0 years old）.Four cases were complicated with ectopic ureter,1 case with urinary tract infection.Doppler imaging,intravenous pyelogram（IVP）,delayed enhanced three dimensional computerized tomography（CT） and 99Tcm-diethylenetriaminepentaacetic acid（DTPA） renal scintigraphy were performed in all children.Results Doppler imaging located dysplastic kidney in 6 cases,the dilated ureter was demonstrated in 1 case.IVP failed to visualize the affected kidney in all cases.Delayed enhanced three-dimensional CT could locate dysplastic kidney in all the cases.Four dysplastic kidneys and 5 ureters were identified by 99Tcm-DTPA renal scintigraphy.All the children underwent transperitoneal laparoscopic nephroureterctomy successfully.Mean operative time was 75 minutes（ranged 61-162 minutes）.There were no intraoperative or postoperative complications.Urinary incontience disappeared and urinary tract infection was cured postoperatively.Mean postoperative hospital stay was 4.2 days（ranged from 3 to 5 days）.The follow-up from 3 months to 5 years showed the children recovered uneventfully and had normal micturition.Conclusions Laparoscopic nephroureterctomy for dysplastic kidney is a safe and effective method,and can be carried out successfully,despite a failure by preoperative imaging studies to localize the dysplastic kidney.
出处
《实用儿科临床杂志》
CAS
CSCD
北大核心
2010年第17期1361-1363,共3页
Journal of Applied Clinical Pediatrics
关键词
单侧肾发育不良
腹腔镜肾输尿管切除
儿童
unilateral dysplastic kidney
laparoscopic nephroureterectomy
child
