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目的探讨双侧输尿管末段狭窄性梗阻致尿闭的临床特点、诊断及治疗。方法先天性双侧输尿管末段狭窄患儿7例,男2例,女5例,年龄35~57 d。临床表现为突发性尿闭或少尿,均行B超、膀胱造影及肾盂穿刺造影,3例行磁共振尿路水显像,诊断明确后行输尿管狭窄段切除、输尿管再植术。结果7例患儿均经肾盂穿刺造影确诊,一期手术后6例治愈,随诊2~4年未发现输尿管狭窄及返流发生,肾功能恢复良好;1例症状复发,二次手术后治愈。结论对生后突发尿闭患儿应考虑先天性双侧输尿管末段狭窄的可能,肾盂穿刺造影及磁共振尿路水显像可明确诊断,输尿管狭窄段切除、输尿管再植术是有效的治疗方法。
Objective To investigate the clinical features, diagnosis and treatment of ureteral stricture caused by bilateral distal ureter obstruction. Methods 7 cases of congenital bilateral ureteral stenosis in children, 2 males and 5 females, aged 35 ~ 57 d. Clinical manifestations of sudden urinary tract obstruction or oliguria, were performed B-mode, cystography and pelvis puncture, 3 cases of magnetic resonance urinary tract imaging, clear diagnosis of ureteral stricture resection, ureter replantation. Results All the 7 cases were diagnosed by pelvic puncture angiography. Six cases were cured after one operation. Ureteral stenosis and regurgitation were not seen 2 to 4 years after operation. Renal function recovery was good. One case had symptoms recurrence and the second operation was cured . Conclusions The incidence of stenosis of congenital bilateral ureter should be considered in children with sudden urinary occlusion after birth. Peritoneal puncture and MR urography can be diagnosed clearly, ureteral stricture resection and ureter replantation are effective treatment method.