Frering V, Sabatier E, Takvorian P, Dodat H
Département d'Urologie Pédiatrique, Hôpital Edouard-Herriot, Lyon.
Prog Urol. 1991 Dec;1(6):1000-5.
Ureteropelvic junction obstruction in children: evolution of diagnosis and treatment. 180 hydronephrosis due to ureteropelvic junction obstruction in 162 patients have been referred to our hospital. The patients were all infants and children with an age ranging between 1 day to 15 years. Out of 9 abstinences (grade I or 11) and 7 nephrectomies for destroyed kidneys (3 of them after temporary nephrostomy), we performed 164 ureteropelvic junction resections and anastomosis, 51 of them with associated pyeloplasty. The use of a stenting catheter passing through the anastomosis and coming out as a nephrostomy in 81 cases gave us 5 mechanical complications while the complete absence of drainage gave only 3 fistulaes. 2 of these fistulaes had a spontaneous rapid healing after endoscopic ureteral catheterism. Out of 160 follow-up cases, we reoperated 6 failures with success: 5 ureteropelvic reanastomoses and one ureterocalycostomy. This study shows us that the early treatment due to antenatal ultrasound diagnosis improves the prognosis. Renal scanning with furosemide test permits to specify the surgical indication in limited cases and the presence of a residual obstruction in case of persistance of renal pelvis dilatation in the postoperative period. The posterior approach and the absence of internal drainage simplify the treatment, improve the patient comfort and limit the hospitalisation period to 5 days.
诊断与治疗的进展。我院共收治162例因肾盂输尿管连接处梗阻导致肾积水的患儿，年龄在1天至15岁之间。在9例保守治疗（Ⅰ级或Ⅱ级）及7例因肾毁损而行肾切除术（其中3例在临时肾造瘘术后）中，我们实施了164例肾盂输尿管连接处切除及吻合术，其中51例同时行肾盂成形术。81例术中使用经吻合口置入并引出成为肾造瘘管的支架管，出现5例机械性并发症，而完全无引流仅导致3例瘘形成。其中2例瘘在内镜下输尿管插管后迅速自愈。在160例随访病例中，6例手术失败后再次手术成功：5例行肾盂输尿管重新吻合术，1例行输尿管肾盂造口术。本研究表明，产前超声诊断后的早期治疗可改善预后。速尿试验肾扫描有助于在有限病例中明确手术指征，并在术后肾盂持续扩张时确定是否存在残余梗阻。后侧入路及无内引流简化了治疗，提高了患者舒适度，并将住院时间限制在5天。
