Sarhan Osama M, Helmy Tamer E, Hafez Ashraf T, Ghali Ahmad M, Mohsen Tarek, Dawaba Mohammed E
Urology and Nephrology Center, Mansoura University, Mansoura 35516, Egypt.
J Pediatr Urol. 2009 Apr;5(2):78-81. doi: 10.1016/j.jpurol.2008.08.005. Epub 2008 Oct 14.
We report our experience with ureterocalyceal anastomosis in children regarding indications and outcome.
A retrospective review was performed of all cases that underwent open ureterocalyceal anastomosis at our center between 2000 and 2006. Records were reviewed for patient age, history, affected side, indication of surgery and operative details. Clinical and radiological outcome was assessed. Success was defined as both symptomatic relief and radiographic resolution of obstruction at last follow up.
There were 10 cases (six males, four females) with a mean age of 6.5 years (range 3-13 years). Follow up ranged from 6 to 46 months (mean 18). The indications for surgery were failed pyeloplasty in six patients and iatrogenic injury of the ureteropelvic junction or the upper ureter in four. No significant perioperative complications were encountered in the study group. Overall success rate was 80%. Relief of obstruction was evident in eight patients as documented by intravenous urography or nuclear renography, while secondary nephrectomy was necessitated in two patients with severely impaired ipsilateral renal function and normal contralateral kidney. In patients with preserved renal units, the differential function on the involved side was stable on comparing the preoperative and postoperative renographic clearance (26 vs 24 ml/min).
Ureterocalyceal anastomosis in children is still indicated in some difficult situations. Excellent functional results can be achieved in properly selected cases. Nephrectomy may be indicated in cases with impaired renal function and inability to perform salvage procedure.
我们报告我们在儿童输尿管肾盂吻合术方面的经验，包括适应证和治疗结果。
对2000年至2006年在本中心接受开放性输尿管肾盂吻合术的所有病例进行回顾性研究。查阅患者年龄、病史、患侧、手术适应证及手术细节等记录。评估临床和影像学结果。成功定义为末次随访时症状缓解且梗阻在影像学上得到解决。
共10例（男6例，女4例），平均年龄6.5岁（3 - 13岁）。随访时间为6至46个月（平均18个月）。手术适应证为6例肾盂成形术失败，4例输尿管肾盂交界处或上段输尿管医源性损伤。研究组未出现明显的围手术期并发症。总体成功率为80%。静脉肾盂造影或核素肾图显示8例梗阻缓解，2例患侧肾功能严重受损且对侧肾功能正常的患者需要行二期肾切除术。在保留肾单位的患者中，患侧术前和术后肾图清除率的差异功能稳定（26 vs 24 ml/min）。
儿童输尿管肾盂吻合术在某些困难情况下仍有应用指征。在适当选择的病例中可取得良好的功能结果。对于肾功能受损且无法进行挽救性手术的病例，可能需要行肾切除术。
