Stein R, Ikoma F, Salge S, Miyanaga T, Mori Y
Department of Urology, Hyogo College of Medicine, Nishinomiya, Japan.
Int J Urol. 1996 Sep;3(5):348-55. doi: 10.1111/j.1442-2042.1996.tb00552.x.
Dilatation of the upper urinary tract is the most common congenital urogenital anomaly. Pyeloplasty is the therapy of choice in those patients with significant obstruction of the ureteropelvic junction. There are not many reports concerning the operative long-term results from a morphologic point of view. Furthermore, little information is available about children with giant hydronephrosis treated without resection of the dilated renal pelvis.
Between 1973 and 1993, 231 children with 262 renal units (kidney, renal pelvis, ureter) were treated at our institution. Giant hydronephrosis was observed in 52 renal units. The clinical and follow-up data were obtained from the patients' records. The dilatation of the upper urinary tract, confirmed by means of intravenous pyelogram, was divided into 5 grades.
In 215 renal units, reconstructive surgery was performed without reduction of the renal pelvis. Revision of the pyeloplasty was necessary in 5 of the 215 renal units. The dilatation of the upper urinary tract improved or remained stable in 99.4% of the renal units during the follow-up period of 4.8 years (range, 1 month to 21 years).
Surgical reconstruction of the ureteropelvic junction obstruction is a safe and successful procedure. The excision of the dilated pelvis does not seem to be necessary, even in patients with giant hydronephrosis.
上尿路扩张是最常见的先天性泌尿生殖系统异常。肾盂成形术是治疗输尿管肾盂连接处明显梗阻患者的首选疗法。从形态学角度来看，关于手术长期结果的报道并不多。此外，对于未经扩张肾盂切除术治疗的巨大肾积水患儿，相关信息也很少。
1973年至1993年间，我们机构共治疗了231名患有262个肾单位（肾脏、肾盂、输尿管）的儿童。52个肾单位观察到巨大肾积水。临床和随访数据从患者记录中获取。通过静脉肾盂造影证实的上尿路扩张分为5级。
215个肾单位进行了重建手术，未对肾盂进行缩减。215个肾单位中有5个需要对肾盂成形术进行修正。在4.8年（范围1个月至21年）的随访期内，99.4%的肾单位上尿路扩张情况得到改善或保持稳定。
输尿管肾盂连接处梗阻的手术重建是一种安全且成功的手术。即使是巨大肾积水患者，似乎也无需切除扩张的肾盂。
