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目的探讨重复肾输尿管畸形诊断治疗方法,提高诊治水平。方法回顾性分析1998-03～2008-08收治的23例重复肾输尿管畸形的临床病例资料,其中男性4例,女性19例,年龄9～36岁,症状分别为:腰腹部胀痛或包块10例,漏尿5例,反复发热4例,膀胱刺激征4例。辅助检查:超声23例,静脉肾盂造影(IVU)23例,膀胱镜检查逆行肾盂造影(RPG)13例,CT检查16例,磁共振泌尿系水成像(MRU)4例。明确诊断重复肾输尿管畸形,23例均行个体化手术治疗。结果 23例全部经手术治疗康复出院,17例获随访6个月～5年,其中1例出现后腹腔尿性囊肿,经再次手术切除剩肾而治愈,2例仍出现轻度肾积水,予观察肾积水未加重而未处理。结论对于重复肾输尿管畸形的诊断,临床表现结合超声、IVU检查对部分病例可明确诊断,而对肾积水严重、肾功能低下IVU显影淡薄或不显影,仅显示正常肾管道系统,易造成误诊或漏诊;RPG可明确重复肾输尿管积水原因和部位,但为有创检查;CT检查快速、简便,可显示重复肾输尿管畸形部位,为手术方案和切口选择提供依据;MRU诊断重复肾输尿管异位开口具有较高准确性和敏感性,能对其作出较好诊断。治疗上应视畸形的病变部位及并发症严重程度采取个体化的手术治疗。
Objective To investigate the diagnosis and treatment of renal ureter malformations and to improve the diagnosis and treatment. Methods Retrospective analysis of 23 cases of recurrent renal ureter malformations admitted in our hospital from March 1998 to August 2008 included 4 males and 19 females, ranging in age from 9 to 36 years with symptoms of lumbar and abdominal pain or mass 10 cases, leakage of urine in 5 cases, recurrent fever in 4 cases, 4 cases of bladder irritation. Auxiliary examinations included 23 cases of ultrasound, 23 cases of intravenous pyelography (IVU), 13 cases of cystoscopy retrograde pyelography (RPG), 16 cases of CT and 4 cases of magnetic resonance urography (MRU). A clear diagnosis of repeated renal ureter deformity, 23 patients underwent individualized surgery. Results All the 23 cases were discharged after operation, 17 cases were followed up for 6 months to 5 years. Among them, 1 case had retroperitoneal urogenital cyst which was cured by reoperation and left nephrectomy. Two cases still showed mild hydronephrosis, To observe hydronephrosis was not aggravated and untreated. Conclusion For the diagnosis of repeated renal ureter malformations, clinical manifestations combined with ultrasonography, IVU examination can be clearly diagnosed in some cases, and severe hydronephrosis, renal dysfunction IVU development was thin or not, only shows the normal renal duct system, can easily lead to misdiagnosis Or missed diagnosis; RPG can clearly reproduce the cause and location of hydronephrosis of the ureter, but for invasive examination; CT examination is quick and easy, can display the site of repeated renal ureter malformations, provide the basis for surgical options and incision selection; MRU diagnosis of repeated renal ureter Bit openings with high accuracy and sensitivity, can make a better diagnosis of it. Treatment should be treated as deformity lesions and the severity of complications to take individualized surgical treatment.