Peng H C, Chen H C
Department of Surgery, Taichung Veterans General Hospital, Taiwan, ROC.
Zhonghua Yi Xue Za Zhi (Taipei). 2000 Mar;63(3):182-8.
A variety of clinical problems due to complete ureteric duplication (CUD) in children may be encountered. Surgical management of CUD varies and is controversial. Therefore, we reviewed the cases of 15 children with CUD operated on at our hospital in an effort to evaluate the various facets of this disorder that influenced our surgical management.
Fifteen children with abnormalities associated with CUD underwent surgery from 1987 to 1998. There were 14 girls and one boy. Their age at surgery ranged from 15 days to 3.5 years (average, 9.5 months). All children underwent ultrasonography, including 10 intravenous urograms and five prenatal examinations. The anatomic abnormalities of all children were noted according to the Weigert-Meyer rule.
Six of 15 ultrasonograms were misinterpreted as hydronephrosis only, while the 10 intravenous urograms were interpreted correctly as CUD. Four patients had recurrent urinary tract infections after surgery. Two of them underwent further surgery, one for stone formation in the residual ureter stump and the other for persistent ureterocele. There was one surgical complication after an upper pole nephroureterectomy. It involved ureteric necrosis with urine leakage. This patient underwent ipsilateral lower pole nephrectomy 28 days after the first operation. All children remained symptom-free during follow-up.
Accurate diagnosis of duplex kidney requires careful imaging studies, especially for fetal renal abnormalities. Management of CUD should be individualized. Usually, upper pole nephroureterectomy is performed for a nonfunctioning moiety. For functioning segments, ureteropyelostomy or ureteric reimplantation can be considered. The results are satisfactory, but long-term follow-up is necessary.
儿童完全性输尿管重复畸形（CUD）可能引发多种临床问题。CUD的手术治疗方式多样且存在争议。因此，我们回顾了我院收治的15例接受手术治疗的CUD患儿病例，旨在评估影响我们手术治疗的该疾病的各个方面。
1987年至1998年，15例伴有CUD相关异常的患儿接受了手术。其中有14名女孩和1名男孩。他们手术时的年龄在15天至3.5岁之间（平均9.5个月）。所有患儿均接受了超声检查，其中10例进行了静脉肾盂造影，5例进行了产前检查。根据魏格特-迈耶法则记录了所有患儿的解剖异常情况。
15例超声检查中有6例仅被误诊为肾积水，而10例静脉肾盂造影均被正确诊断为CUD。4例患儿术后反复发生尿路感染。其中2例接受了进一步手术，1例因残留输尿管残端结石形成，另1例因输尿管囊肿持续存在。1例患儿在上极肾输尿管切除术后出现手术并发症。涉及输尿管坏死并伴有尿液渗漏。该患儿在首次手术后28天接受了同侧下极肾切除术。所有患儿在随访期间均无症状。
双肾盂的准确诊断需要仔细的影像学检查，尤其是对于胎儿肾脏异常。CUD的治疗应个体化。通常，对于无功能部分行上极肾输尿管切除术。对于有功能的节段，可考虑输尿管肾盂吻合术或输尿管再植术。结果令人满意，但需要长期随访。
