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目的探讨小婴儿中重度肾积水治疗方法的选择及提高疗效的方法。方法回顾性分析28例小婴儿肾积水的诊断和治疗经过,其中23例经B超及静脉肾盂造影证实,肾盂扩张>2 cm,伴肾盏扩张,直接行离断式肾盂成形术(直接手术组);5例巨大肾积水患儿(造瘘组)先行经皮肾微穿刺造瘘,观察4～12周,后行离断式肾盂成形术。结果直接手术组中1例因双J管位置移动而出现尿外渗,急诊手术重新放置双J管,漏尿停止,1例吻合口狭窄被迫二次手术。造瘘组经观察患肾缩小,肾皮质增厚,尿量稳定在20 mL·kg-1·d-1以上,于4～12周行肾盂成形术。患儿术后均规律随访,复查B超,患儿肾积水均得到改善,无肾盂增大或分离。结论小婴儿肾积水一般不考虑切除肾脏,对肾盂扩张的患儿应考虑早期手术干预,根据积水程度采取不同的手术方式。重度肾积水患儿应先行微造瘘,再行肾盂成形,可提高疗效。
Objective To explore the selection of small and medium-sized hydronephrosis in children and improve the curative effect. Methods The diagnosis and treatment of hydronephrosis in 28 infants were retrospectively analyzed. Twenty-three of the 23 cases were confirmed by B-mode ultrasonography and intravenous pyelography. The dilated renal pelvis was more than 2 cm in diameter with dilated calyx. Surgery group); 5 cases of children with hydronephrosis (fistula group) percutaneous renal microperitoneal puncture fistula, observed 4 to 12 weeks, after the disconnection pyeloplasty. Results In the direct operation group, one case had urinary extravasation due to the displacement of the double J tube. The double J tube was placed again in the emergency operation. The leakage of urine was stopped and one case of anastomotic stenosis was forced to undergo secondary surgery. Fistula group was observed with renal shrinkage, renal cortex thickening, urine output stabilized at 20 mL · kg-1 · d-1 or more, in 4 to 12 weeks underwent pyeloplasty. Regular follow-up of children with surgery, review B ultrasound, hydronephrosis in children have been improved, no enlargement or separation of the renal pelvis. Conclusion Small infants with hydronephrosis generally do not consider the excision of the kidneys. Early surgical intervention should be considered in children with dilated renal pelvis. Different surgical procedures should be taken according to the degree of hydrops. Children with severe hydronephrosis should be the first micro-fistula, re-pyeloplasty, can improve the curative effect.