Liu Wei, Du Guoqiang, Guo Feng, Ma Rui, Wu Rongde
Department of Pediatric Surgery, Provincial Hospital Affiliated To Shandong University, Jinan, 250021, China.
Department of Pediatric Surgery, The People's Hospital of Linyi City, Linyi, 276003, China.
Int Urol Nephrol. 2016 Dec;48(12):1937-1941. doi: 10.1007/s11255-016-1409-6. Epub 2016 Sep 2.
To describe a modified ureteral orthotopic reimplantation method in infant with primary obstructive megaureter (POM) and report our initial experience.
Thirteen children with POM (range 1-7 months) underwent modified transvesical ureteral implantation surgery. Treatment consists of transecting the ureter proximal to the obstruction and performing orthotopic reimplantation in end freely fashion with distal ureter protruding into the bladder, providing dilated ureteral diameter: ureteral exposure length in bladder ratio of 1:1.5-2. All patients underwent repeat ultrasound, radionuclide imaging and voiding cystourethrography. Cystoscopy was conducted in patients at 6 months after surgery.
The mean operating time was 40 min. There were one redo this procedure for recurrent obstruction and one Cohen reimplantation for Grade 5 vesico-ureteral reflux in one bilateral POM. Hydroureteronephrosis improved in other 11 patients, and the ureter diameter was significantly reduced from preoperative measurements. At the time of cystoscopy, thick and large volcanic-shaped ureteral orifice was found and urine ejected intermittently.
The proposed 'modified ureteral orthotopic reimplantation' with no tapering or advancement for POM in infants is a simple, feasible and less invasive procedure that had good success rates in this small series. Further, larger studies are required to support or negate the usefulness of this technique.
描述一种改良的原发性梗阻性巨输尿管（POM）婴儿输尿管原位再植方法，并报告我们的初步经验。
13例POM患儿（年龄1 - 7个月）接受改良经膀胱输尿管植入手术。治疗方法包括在梗阻近端横断输尿管，并将输尿管远端以末端自由方式原位再植，使其突出于膀胱内，使输尿管直径与输尿管在膀胱内的暴露长度之比为1:1.5 - 2。所有患者均接受了重复超声、放射性核素显像和排尿性膀胱尿道造影检查。术后6个月对患者进行膀胱镜检查。
平均手术时间为40分钟。1例因复发性梗阻接受了再次手术，1例双侧POM患者因5级膀胱输尿管反流接受了科恩（Cohen）再植手术。其他11例患者的肾积水有所改善，输尿管直径较术前测量值明显减小。膀胱镜检查时，发现输尿管口呈粗大的火山状，尿液间歇性喷出。
所提出的婴儿POM“改良输尿管原位再植术”，不进行输尿管变细或推进，是一种简单、可行且侵入性较小的手术，在这个小系列研究中成功率良好。此外，需要更大规模的研究来支持或否定该技术的实用性。
