Jayakumar Sivasankar, Antao Brice A, Ninan George Kaithayil
Department of Paediatric Urology, University Hospitals Leicester, Leicester, East Midlands, United Kingdom.
Eur J Pediatr Surg. 2012 Aug;22(4):279-82. doi: 10.1055/s-0032-1313336. Epub 2012 Jul 7.
Pelvi-ureteric junction (PUJ) obstruction associated with malrotated kidney is very rare. In such cases, dismembered pyeloplasty poses technical difficulties. We present our experience with management of PUJ obstruction in malrotated kidneys in children and their outcomes.
Retrospective review of case notes of all children who had pyeloplasty for PUJ obstruction associated with malrotated kidneys, over a period of 7 years between January 2003 and December 2009 at our institution.
We identified four patients, and all four patients had malrotated kidneys with a lateral and slightly inferior facing renal pelvis. Anderson and Hynes dismembered pyeloplasty with inferior pelvi-ureteric anastamosis was performed in two patients (one patient with nephropexy and one patient without nephropexy), but failed to improve the drainage across the PUJ in both the patients. The remaining two patients underwent a dismembered pyeloplasty with anterior pelvi-ureteric anastamosis that resulted in a good drainage. One of the patients who had pyeloplasty with inferior pelvi-ureteric anastamosis had a redo pyeloplasty with anterior pelvi-ureteric anastamosis that restored the drainage adequately.
In our experience dismembered pyeloplasty with inferior pelvi-ureteric anastamosis along with or without nephropexy has not been successful in cases of PUJ obstruction in laterally malrotated kidneys. Although the number of cases in our study is small, we have had a 100% success with dismembered pyeloplasty with anterior pelvi-ureteric anastamosis. The authors are of the opinion that this modified approach is recommended as a viable option both as a primary and salvage procedure for PUJ obstruction in laterally malrotated kidneys.
肾盂输尿管连接处（PUJ）梗阻合并肾脏旋转不良非常罕见。在此类病例中，离断性肾盂成形术存在技术难题。我们介绍我们在儿童旋转不良肾脏的PUJ梗阻管理方面的经验及其结果。
回顾性分析2003年1月至2009年12月在我们机构接受因PUJ梗阻合并肾脏旋转不良而行肾盂成形术的所有儿童的病历。
我们确定了4例患者，所有4例患者的肾脏均旋转不良，肾盂朝向外侧且略向下。2例患者（1例患者行肾固定术，1例患者未行肾固定术）接受了Anderson和Hynes离断性肾盂成形术并进行了低位肾盂输尿管吻合，但2例患者的PUJ引流均未改善。其余2例患者接受了离断性肾盂成形术并进行了前方肾盂输尿管吻合，引流良好。1例接受低位肾盂输尿管吻合的肾盂成形术患者再次接受了前方肾盂输尿管吻合的肾盂成形术，引流得到充分恢复。
根据我们的经验，对于外侧旋转不良肾脏的PUJ梗阻病例，无论是否行肾固定术，低位肾盂输尿管吻合的离断性肾盂成形术均未成功。尽管我们研究中的病例数量较少，但前方肾盂输尿管吻合的离断性肾盂成形术成功率为100%。作者认为，这种改良方法作为外侧旋转不良肾脏PUJ梗阻的初次和挽救性手术的可行选择被推荐。
