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儿童肾积水外伤性破裂诊治分析

Diagnosis and treatment of traumatic rupture of hydronephrosis in children

摘要:

目的:探讨儿童肾积水合并外伤性破裂的诊断和治疗方法,提高其预后。方法:回顾性分析2009年1月至2019年5月首都医科大学附属北京儿童医院收治的10例肾盂输尿管连接处梗阻(UPJO)致肾积水合并外伤性破裂患儿的临床资料。男6例,女4例。年龄8~10个月3例,4岁1例,7~12岁6例。病变位于左侧7例,右侧3例。受伤原因:坠落伤6例(坠床3例,坠房、坠单杠、坠三轮车各1例),撞伤4例。临床表现为腹痛10例,血尿4例,腹部包块3例,发热1例。病程:伤后48 h内3例,1周内2例,3~4周4例,外院肾造瘘术后1年1例。10例术前均行超声和增强CT检查确诊。结果:9例行开放式肾盂成形术,术中见肾实质变薄,厚度为2~4 mm,破裂位于肾实质4例、肾盂4例、位置不详1例;余1例外伤后未及时治疗,因合并肾周感染行肾造瘘术。10例术后均获随访,随访时间6个月至10年,9例行肾盂成形术患儿患肾功能良好,2例已到青春期,未出现血压增高;1例因肾周感染行肾造瘘患儿术后6个月复查肾核素扫描示患侧分肾功能<5%,行肾切除术,术后未再出现泌尿系感染。结论:儿童肾积水受外伤可致肾盂或肾实质破裂,术前超声和增强CT检查表现为肾实质变薄、肾盂扩张、尿液外溢,可明确诊断。如果患儿生命体征平稳,专科医生在修复裂伤同期可行肾盂成形术;如医生或患者一方条件不能满足肾盂成形术时可暂行肾造瘘术。

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abstracts:

Objective:To investigate the diagnostics and treatment of hydronephrosis associate with traumatic rupture in children and improve the prognosis.Methods:A retrospective study was conducted on our 10 patients, including 6 male and 4 female, from January 2009 to May 2019 combined with literature review. Their age ranged from 8 month to 12 years. All of them were diagnosed as the hydronephrosis due to the ureteropelvic junctional obstruction (UPJO)associated traumatic renal rupture. There were 6 cases with falling injury, including falling bed in 3 cases, falling house, falling bar and tricycle in each one.4 cases suffered with crush injury. The clinical manifestations were abdominal pain in 10 cases, hematuria in 4 cases, abdominal mass in 3 cases and urinary tract infection in one case. Before admission, three cases waited 48 hours, 2 cases waited 1 week and 4 cases waited 3-4 weeks after injury.One patient accepted the nephrostomy in the other hospital. All the patients were diagnosed by ultrasound and enhanced CT.Results:Nine patients performed pyeloplasty and 1 patient was nephrostomy because of perirenal abscess. The thickness of renal parenchyma was with 2-4 mm. The laceration was at renal parenchyma in 4 cases and renal pelvis in 4 cases. The position in the remaining one is unclear. Following up ranged from 6 month to 10 years. 9 patients keep good renal function. 2 patients were in the adolescent phase without any evidence of high blood pressure. The patient with nephrostomy performed nephrectomy because of poor renal function. No urinary tract infection occurred after the operation.Conclusions:Children with UPJO trauma can cause rupture of the renal pelvis or renal parenchyma. Ultrasound indicates thinning of the renal parenchyma, dilatation of the renal pelvis, and overflow of urine, which can be used for diagnosis. Enhanced CT or IVP can further understand kidney function. If the vital signs of the child are stabilized, the laceration repairing and the pyeloplasty can be perform simultaneously. For example, if the condition of the doctor or the patient cannot satisfy the pyeloplasty, the Nephrostomy can be temporarily performed.

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作者: 李振武 [1] 宋宏程 [1] 孙宁 [1] 张潍平 [1] 田军 [1] 李明磊 [1] 李宁 [1] 黄澄如 [1]
作者单位: 国家儿童医学中心 首都医科大学附属北京儿童医院泌尿外科,北京 100045 [1]
期刊: 《中华泌尿外科杂志》2020年41卷12期 906-909页 ISTICPKUCSCDCA
栏目名称: 临床研究
DOI: 10.3760/cma.j.cn112330-20191128-00535
发布时间: 2021-01-11
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