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目的探讨儿童肾盂输尿管连接部梗阻肾盂输尿管成形术术后并发症的原因、处理和预防。方法 1996年1月-2010年10月中山大学附属第一医院收治的肾盂输尿管连接部梗阻行肾盂输尿管成形术术后发生并发症患儿共22例。男20例,女2例;年龄8 d~9岁(平均3.5岁);左侧20例,右侧2例。对患儿进行随访,并结合其临床资料进行回顾性分析。结果 22例中吻合口狭窄10例,其中8例行再次肾盂输尿管成形术,2例行吻合口瘢痕松解、瘢痕狭窄切除再吻合;吻合口水肿伴泌尿系感染6例,3例行肾造瘘,3例延期拔除原肾造瘘管;单纯泌尿系感染2例,行抗感染治疗;输尿管中段狭窄1例,行输尿管中段狭窄切除再吻合;输尿管末段狭窄1例,行输尿管膀胱再吻合术;吻合口血肿伴泌尿系感染1例,行血肿穿刺引流、肾穿刺造瘘;巨大肾积水并无功能肾1例,行肾切除。10例吻合口狭窄切除标本病理:输尿管慢性炎症,肌层增厚;2例输尿管中、末段狭窄切除标本病理:输尿管慢性炎症,管壁变薄;1例肾切除标本病理:肾实质不同程度萎缩,间质慢性炎症并不同程度纤维化。随访6~36个月,临床症状均已消失,复查尿常规均无异常。超声检查21例患侧肾积水均减轻、肾皮质均有不同程度增厚;另1例患肾切除术后超声检查示对侧肾脏代偿性增大。结论肾盂输尿管成形术术后需要密切随访,及时发现和治疗并发症。术前正确诊断,术中细致操作,术后精心护理及预防性使用抗生素均是预防并发症措施。
Objective To investigate the causes, management and prevention of complications after ureteropelvic junction obstruction in children with ureteropelvic ureteroplasty. Methods From January 1996 to October 2010, 22 cases of complications of ureteropelvic junction obstruction underwent ureteroplasty in the First Affiliated Hospital of Sun Yat-sen University. 20 males and 2 females; aged 8 to 9 years (mean 3.5 years); left 20 cases, right 2 cases. Follow-up of children, combined with clinical data for retrospective analysis. Results Of the 22 cases, anastomotic stenosis was observed in 10 cases, of which 8 cases underwent ureteroplasty, 2 cases underwent anastomotic scar release and scar stenosis resection and anastomosis. Anastomotic edema and urinary tract infection were performed in 6 cases and 3 cases were treated by nephrology Fistula, 3 cases of protracted removal of the original renal fistula; simple urinary tract infection in 2 cases, anti-infection treatment; ureteral stenosis in 1 case, the middle ureteral stricture resection and anastomosis; ureteral stricture in 1 case, ; Anastomotic hematoma with urinary tract infection in 1 case, hematoma puncture and drainage, renal puncture fistula; huge hydronephrosis and no functional kidney in 1 case, the line of nephrectomy. 10 cases of anastomotic stenosis resection specimens pathology: ureteral chronic inflammation, muscular thickening; 2 cases of ureteral, distal stenotic resection specimens pathology: chronic ureteral inflammation, thinning of the wall; 1 case of nephrectomy specimens: varying degrees of renal parenchyma Atrophy, interstitial chronic inflammation and varying degrees of fibrosis. Follow-up 6 to 36 months, the clinical symptoms have disappeared, no abnormal urine examination. Ultrasound examination of 21 cases of hydronephrosis were reduced, renal cortex were varying degrees of thickening; the other case of patients with nephrectomy ultrasound showed contralateral renal compensatory increase. Conclusions The ureteropelvic ureteroplasty needs close follow-up and timely detection and treatment of complications. Preoperative correct diagnosis, intraoperative meticulous operation, meticulous care and preventive use of antibiotics are complications prevention measures.