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目的 :探讨先天性血管压迫致输尿管梗阻的诊断与治疗方法。方法 :术前采用 B超、静脉尿路造影(IVU)、逆行尿路造影和磁共振水成像 (MRU)诊断先天性血管压迫致输尿管和肾积水患者 19例 ,均采用手术治疗 ,术中切断腔静脉后输尿管、切除异位血管和切除受压部分输尿管后作输尿管端端吻合或肾盂整形术。结果 :手术证实下腔静脉压迫致输尿管梗阻 8例 ,异位血管压迫致输尿管梗阻 10例 ,左侧髂总动脉压迫致输尿管梗阻 1例。术后 3～ 6个月随访 ,肾脏、输尿管积水减轻 ;术后 1～ 4.5年 (平均 1.4年 )随访 ,18例患者肾脏、输尿管积水明显减轻 ,肾功能良好 ;1例患者肾积水虽减轻 ,但出现肾脏萎缩 ,肾功能不良。结论 :先天性血管压迫是输尿管和肾积水的原因之一 ;B超、IVU和 MRU结合 MRI、腔静脉造影和彩色多普勒超声检查对先天性血管压迫致输尿管梗阻的诊断有较大价值 ;手术仍是治疗先天性血管压迫致输尿管梗阻的首选方法。
Objective: To investigate the diagnosis and treatment of ureteral obstruction caused by congenital vascular compression. Methods: Nineteen patients with ureteral and hydronephrosis diagnosed by congenital vascular compression were diagnosed preoperatively by using B-mode ultrasonography, IVU, retrograde urography and magnetic resonance imaging (MRU) Cut off the vena cava ureter, resection of the ectopic blood vessels and resection of the ureter after partial ureteral anastomosis or renal pelvis plastic surgery. Results: Surgical confirmation of inferior vena cava obstruction caused by ureteral obstruction in 8 cases, ectopic vascular compression caused by ureteral obstruction in 10 cases, left common iliac artery compression caused by ureteral obstruction in 1 case. After 3 to 6 months of follow-up, the kidneys and ureteral hydronephrosis were relieved. After 1 to 4.5 years (mean 1.4 years) follow-up, the renal and ureteral hydronephrosis were significantly reduced and the renal function was good in 18 patients. One patient had hydronephrosis Although reduced, but there renal atrophy, renal dysfunction. CONCLUSIONS: Congenital vascular compression is one of the causes of ureter and hydronephrosis. B-ultrasound, IVU and MRU combined with MRI, vena cava angiography and color Doppler ultrasonography have great value in the diagnosis of ureteral obstruction caused by congenital vascular compression ; Surgery is still the preferred method of treatment of ureteral obstruction caused by congenital vascular compression.