Mor Y, Mouriquand P D, Quimby G F, Soonawalla P F, Zaidi S Z, Duffy P G, Ransley P G
Department of Urology, Great Ormond Street Hospital, London, United Kingdom.
J Urol. 1996 Aug;156(2 Pt 2):683-5.
We assessed the role and long-term outcome of lower pole heminephrectomy in the treatment of nonfunctioning lower renal moieties in children with duplex kidneys.
Between 1979 and 1994, 54 lower pole heminephrectomies were performed in 53 patients 1 to 192 months old (mean age 54) with duplex systems. A total of 15 patients was prenatally diagnosed, while the others presented with a urinary tract infection (36), orchiepididymitis (1) and failure to thrive (1). The surgical technique was essentially similar to that of upper pole heminephrectomy.
Operative course was uneventful except for intraoperative bleeding in 5 cases, which necessitated blood transfusion, and a postoperative urinary tract infection in 1. Followup ranged from 3 to 168 months (mean 56.9). Postoperative renograms available in 34 cases showed unchanged differential function in 12 and an ipsilateral 2 to 14% decrease (mean 5.65%) in 22. No late complications were detected except in 1 patient, who had postoperative urinary tract infections and subsequently underwent removal of the ureteral stump. Our series includes 4 patients with solitary ipsilateral upper poles (after the contralateral kidney was removed or nonfunctioning) who had good renal function at long-term followup despite the reduced parenchymal mass.
Based on our experience it seems that lower pole heminephrectomy is the treatment of choice in cases of nonfunctioning dilated lower segments of duplicated kidneys.
我们评估了下极半肾切除术在治疗重复肾患儿无功能下肾部分中的作用及长期疗效。
1979年至1994年间，对53例年龄在1至192个月（平均年龄54个月）的重复肾系统患儿实施了54例下极半肾切除术。其中15例为产前诊断，其余患儿表现为尿路感染（36例）、睾丸附睾炎（1例）及发育不良（1例）。手术技术与上极半肾切除术基本相似。
除5例术中出血需输血及1例术后尿路感染外，手术过程顺利。随访时间为3至168个月（平均56.9个月）。34例术后肾图显示，12例分肾功能无变化，22例患侧分肾功能下降2%至14%（平均5.65%）。除1例术后反复尿路感染并随后切除输尿管残端的患者外，未发现晚期并发症。我们的系列病例包括4例同侧孤立上极肾（对侧肾已切除或无功能）患者，尽管肾实质减少，但长期随访肾功能良好。
根据我们的经验，对于重复肾无功能扩张的下段，下极半肾切除术似乎是首选治疗方法。
