Department of Paediatric Urology, Leeds General Infirmary, St James's University Hospital, Leeds, UK.
BJU Int. 2011 Aug;108(3):434-8. doi: 10.1111/j.1464-410X.2010.09925.x. Epub 2010 Dec 13.
• To document the outcome of ureterocalicostomy in children.
• The outcomes of 13 children who had undergone ureterocalicostomy consecutively under the care of two paediatric urologists between 1997 and 2009 were evaluated retrospectively. • Ureterocalicostomy was performed as the primary procedure in four children with horseshoe kidney and four children presenting with gross pelvi-ureteric junction (PUJ) obstruction. • In the remaining five children, it was performed as a secondary procedure for recurrent PUJ obstruction after previous pyeloplasty. • An open approach was employed in 12 patients, whereas, in one patient, it was performed by a laparoscopically-assisted technique.
• Mean age at operation was 9.3 years and the mean (range) duration of follow-up was 2.6 (0.3-7.0) years. Twelve children (92%) experienced a good functional outcome following ureterocalicostomy, as defined by reduced dilatation and improved drainage on postoperative ultrasonography and/or isotope imaging. • However one child (8%) developed symptomatic anastomotic obstruction 5 months after primary ureterocalicostomy for obstruction in a horseshoe kidney. Surgical revision was successful, with good drainage, preservation of differential function and relief of symptoms on further follow-up to 3 years.
• Ureterocalicostomy provides a versatile and reliable means of relieving obstruction for a variety of indications, including horseshoe kidney, recurrent PUJ obstruction and gross PUJ obstruction with unfavourable anatomy. • Approximation of ureteric and caliceal urothelium and excision of renal parenchyma in the proximity to the anastomosis are the key steps for securing a satisfactory outcome.
• 记录儿童输尿管肾盂吻合术的结果。
• 回顾性分析了 1997 年至 2009 年间两位小儿泌尿科医生连续治疗的 13 名儿童的结果。• 在 4 名马蹄肾和 4 名巨肾盂输尿管连接部（PUJ）梗阻患儿中，将输尿管肾盂吻合术作为主要手术。• 在其余 5 名患儿中，在先前肾盂成形术后再次发生 PUJ 梗阻时，将其作为二次手术。• 12 例患者采用开放式手术，1 例患者采用腹腔镜辅助技术。
• 手术时的平均年龄为 9.3 岁，平均（范围）随访时间为 2.6（0.3-7.0）年。12 名儿童（92%）在输尿管肾盂吻合术后功能恢复良好，定义为术后超声和/或同位素成像显示扩张减轻和引流改善。• 然而，1 名儿童（8%）在马蹄肾梗阻行原发性输尿管肾盂吻合术后 5 个月出现吻合口梗阻症状。手术修正成功，进一步随访 3 年，引流良好，保留了差异功能，症状缓解。
• 输尿管肾盂吻合术为各种适应症（包括马蹄肾、复发性 PUJ 梗阻和巨肾盂输尿管连接部梗阻伴不利解剖结构）提供了一种灵活可靠的缓解梗阻的方法。• 输尿管和肾盂尿路上皮的接近和吻合附近肾实质的切除是确保满意结果的关键步骤。
