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肾异位血管压迫引起肾盂输尿管连接部梗阻的临床诊治分析

Diagnosis and treatment of ureteropelvic junction obstruction caused by renal crossing vessels : an analysis of 24 cases

摘要:

目的 探讨肾异位血管压迫所致肾盂输尿管连接部梗阻(UPJO)的临床诊治以及手术效果.方法 回顾性分析2001年6月至2011年9月北京大学第三医院泌尿外科收治因异位血管压迫引起的24例UPJO患者的临床资料,其中男性17例,女性7例;年龄2~ 63岁,平均28岁.病程7d至180个月,平均22.3个月.患者均有患侧肾积水.4例行开放手术,20例行后腹腔镜手术,根据术中异位血管压迫情况决定行粘连松解术、肾盂离断成形术(即Anderson-Hynes术)或非离断成形术(即Y-V吻合术),同时保留或切断压迫的异位血管.术后定期随访患者并评价手术效果.结果 术中发现15例为异位动脉压迫肾盂输尿管连接部(UPJ),8例为异位静脉压迫UPJ(7例为单支,1例为双支),另1例为2支异位动脉与1支异位静脉压迫UPJ.术后11例获得长期随访,随访时间13~120个月,平均48.2个月.8例(8/11)患者临床症状或肾积水缓解,1例(1/11)患者无明显改善,2例(2/11)加重.6例行单纯松解粘连或同时结扎异位血管的患者中,3例缓解,1例无明显改善,2例加重.5例行肾盂离断成形术的患者随访均明显缓解.结论 肾异位动脉所致UPJO较为常见,术中应尽量保留异位动脉.由于异位血管压迫不是导致UPJO的唯一病理原因,对UPJ狭窄部的处理同样重要,肾盂离断成形术的效果确切,而单纯松解粘连效果有限.

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abstracts:

Objective To investigate the diagnosis,treatment and surgical outcomes of ureteropelvic junction obstruction (UPJO) caused by renal crossing vessels.Methods The case records of 24 patients discharged from Peking University Third Hospital between June 2001 and September 2011 with the diagnosis of UPJO caused by renal crossing vessels were reviewed.Of the 24 patients,17 were male and 7 were female patients.The mean age was 28 years (range,2-63 years).The mean disease duration was 22.3 months (range,7 days to 180 months).Of which,4 patients underwent open surgery,and the other 20 patients were treated with laparoscopic surgery.Surgical approach was decided by operative conditions:adhesion release technique,dismembered pyeloplasty or Y-V anastomosisor,with or without cut off the crossing vessels.The kind of crossing vessels was recorded,and the effect of surgery was evaluated by follow-up.Results Fifteen cases were caused by oppressed renal crossing artery,8 cases by renal crossing vein,and 1 case by 2 renal crossing arteries and 1 renal crossing vein.Among them,11 cases were followed up successfully.Average follow-up time was 48.2 months (range,13-120 months).Eight cases (8/11) were relieved,and 1 case(1/11) had no obvious improvement,another 2 cases(2/11) were aggravating.Among those 6 cases underwent adhesion release technique,3 cases were relieved,1 case had no obvious improvement,and 2 cases were aggravating.Five cases who underwent dismembered pyeloplasty was relieved significantly.Conclusions Renal crossing artery is one of the main causes of UPJO,the crossing artery should be retained as far as possible.Crossing vessel oppression is not the only pathological cause of UPJO,so the treatment of UPJ constriction is also very important.Dismembered pyeloplasty seems to be the most efficacies treatment procedure for UPJO caused by repressed vessels,and the remission rate of adhesion release technique seems limited.

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作者: 邱敏 [1] 吴红章 [2] 马潞林 [1] 卢剑 [1] 黄毅 [1] 李刚 [1] 颜野 [1] 李航 [1]
第一作者: 邱敏
期刊: 《中华外科杂志》2014年52卷9期 702-705页 MEDLINEISTICPKUCSCD
栏目名称: 论著
DOI: 10.3760/cma.j.issn.0529-5815.2014.09.016
发布时间: 2014-09-25
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