巨大神经源性肾积水的外科治疗

Surgical management of massive neurogenic hydronephrosis.

作者信息

Rabinowitz R, Barkin M, Schillinger J F, Jeffs R D, Cook G T

出版信息

J Urol. 1979 Jul;122(1):64-5. doi: 10.1016/s0022-5347(17)56256-4.

Abstract

Permanent urinary diversion has been the standard recommended treatment of massive dilatation of the upper tracts in the child with neurogenic vesical dysfunction. Reimplantation of relatively normal caliber ureters into neurogenic bladders has been shown to be effective. However, attempts to save urinary diversion in 39 neurogenic megaureters have been unrewarding, with the salvage rate of 15 per cent, and 64 per cent have been diverted permanently. Upper tract decompression by continuous or intermittent catheterization, nephrostomy or end cutaneous ureterostomy was used in this series. When ureteral caliber responded to decompression a reasonable success rate from non-tailored reimplantation may be anticipated. However, in those instances in which ureteral caliber failed to respond or when tailoring or ureteral caliber was done in conjunction with reconstruction the success rate was much lower.

摘要

永久性尿流改道术一直是治疗神经源性膀胱功能障碍患儿上尿路严重扩张的标准推荐疗法。已证实将相对正常管径的输尿管再植至神经源性膀胱是有效的。然而，为39例神经源性巨输尿管患者保留尿流改道术的尝试均未成功，挽救率为15%，64%的患者已进行永久性尿流改道。本系列采用持续或间歇性导尿、肾造瘘术或经皮输尿管造口术进行上尿路减压。当输尿管管径对减压有反应时，非定制再植术可能会有合理的成功率。然而，在输尿管管径对减压无反应的情况下，或在与重建联合进行剪裁或输尿管管径处理时，成功率要低得多。