Vates T S, Bukowski T, Triest J, Freedman A, Smith C, Perlmutter A, Gonzalez R
Department of Pediatric Urology, Children's Hospital of Michigan, Detroit, USA.
J Urol. 1996 Aug;156(2 Pt 2):744-6. doi: 10.1097/00005392-199608001-00050.
We addressed whether salvage of upper pole renal units in comparison to partial nephrectomy affects differential renal function in patients with a duplicated obstructed upper pole.
We retrospectively reviewed the records of all children who underwent surgery for a unilateral obstructed duplicated kidney at our institution from 1988 to 1995. Patients were evaluated with respect to postoperative complications, reoperation rate and percent change in differential renal function of the obstructed duplicated kidney, as determined by nuclear renography.
We identified 46 patients with a unilateral obstructed upper pole of a duplicated kidney who were divided into 2 groups. Group 1 (12 patients) underwent an upper pole salvage procedure, that is ureteropyelostomy or ureteroureterostomy, and group 2 (31 patients) underwent partial nephrectomy. Three reoperations (25%) were performed in group 1 and 1 (4%) was done in group 2. Postoperative symptomatic urinary tract infections were diagnosed in 3 group 1 patients (25%) and in 2 (8%) in group 2. Average change in ipsilateral renal function in the 8 patients who underwent upper pole salvage procedures was 2.25 +/- 2.34% (range -6 to 12). In the 8 patients who underwent upper pole nephrectomy and who also had postoperative renal scans average change in function was -1.25 +/- 4.51% (range -23 to +16).
There was no statistically significant loss of relative renal function in patients treated with partial nephrectomy and no significant gain in relative renal function in those treated with an upper pole salvage procedure. The reoperation rate was higher in the upper pole salvage than in the partial nephrectomy group (25 versus 4%). While not statistically significant, we believe that this rate is clinically important. We think that partial nephrectomy should remain the preferred treatment for most patients with obstructed duplicated kidneys.
我们探讨了与部分肾切除术相比，保留上极肾单位对重复肾梗阻性上极患者的分肾功能有何影响。
我们回顾性分析了1988年至1995年在我院接受单侧梗阻性重复肾手术的所有儿童的病历。通过核素肾图评估患者术后并发症、再次手术率以及梗阻性重复肾分肾功能的变化百分比。
我们确定了46例单侧重复肾梗阻性上极患者，分为2组。第1组（12例患者）接受了上极保留手术，即输尿管肾盂吻合术或输尿管输尿管吻合术，第2组（31例患者）接受了部分肾切除术。第1组进行了3次再次手术（25%），第2组进行了1次（4%）。第1组有3例患者（25%）被诊断为术后有症状性尿路感染，第2组有2例（8%）。接受上极保留手术的8例患者患侧肾功能的平均变化为2.25±2.34%（范围-6至12）。接受上极肾切除术且术后进行了肾脏扫描的8例患者功能的平均变化为-1.25±4.51%（范围-23至+16）。
接受部分肾切除术的患者相对肾功能无统计学意义上的损失，接受上极保留手术的患者相对肾功能也无显著增加。上极保留组的再次手术率高于部分肾切除组（25%对4%）。虽然无统计学意义，但我们认为该比率具有临床重要性。我们认为部分肾切除术应仍然是大多数重复肾梗阻患者的首选治疗方法。
