Miyamoto K K, Mesrobian H G
Department of Surgery, University of North Carolina at Chapel Hill, USA.
World J Urol. 1996;14(6):380-3. doi: 10.1007/BF00183119.
Pyeloplasty for congenital ureteropelvic junction (UPJ) obstruction enjoys a 90-95% success rate. Although treatment of the failed pyeloplasty has been addressed in the literature, management of the poorly draining or nondraining renal unit in the immediate postoperative period has not received any attention. For this purpose the medical records of 33 consecutive children (37 renal units) treated by dismembered pyeloplasty between 1986 and 1992 were reviewed. All of our pyeloplasties were stented and urine was diverted via a nephrostomy tube. All patients underwent a nephrostogram following stent removal 1 week postoperatively. These studies showed poor drainage, or no, across the newly reconstructed anastomosis in 7 of 37 renal units (19%). The ages of these 4 boys and 3 girls at the time of pyeloplasty ranged between 7 weeks and 5 years (mean 22 months). In four patients, good drainage occurred without intervention by 2-4 weeks postoperation. In two patients, percutaneous balloon dilation of the anastomosis via the intraoperatively placed nephrostomy tube was required at 3 and 6 weeks, respectively. The remaining patient failed percutaneous dilation, necessitating a ureterocalycostomy at 9 weeks following pyeloplasty. The long-term follow-up for the entire group of 33 children averaged 30 months and consisted of radionuclide diuresis renography in 84% of cases or intravenous pyelography in the remainder. All patients had excellent long-term outcomes as assessed by comparison of the postoperative studies with the baseline studies obtained preoperatively. Our results show that kidneys with initially poor drainage, or even no drainage, across the newly reconstructed anastomosis following pyeloplasty can be salvaged with an excellent long-term outcome comparable with that of the group with initially good drainage. In addition, intervention was necessary in only 43% of renal units with initial compromise and was facilitated by the intraoperatively placed nephrostomy tube. We recommend that percutaneous dilation be done at between 4 and 6 weeks postpyeloplasty, as the waiting period was long enough to allow for spontaneous improvement without precluding a successful outcome if drainage failed to occur. Ureterocalycostomy was rarely necessary.
先天性肾盂输尿管连接部（UPJ）梗阻的肾盂成形术成功率为90%至95%。虽然文献中已讨论过肾盂成形术失败后的治疗方法，但术后早期引流不畅或无引流的肾单位的处理尚未受到关注。为此，我们回顾了1986年至1992年间连续接受离断性肾盂成形术治疗的33例儿童（37个肾单位）的病历。我们所有的肾盂成形术都放置了支架，尿液通过肾造瘘管引流。所有患者在术后1周拔除支架后均接受了肾造瘘造影。这些研究显示，37个肾单位中有7个（19%）新重建的吻合口引流不畅或无引流。这些4名男孩和3名女孩在肾盂成形术时的年龄在7周至5岁之间（平均22个月）。4例患者术后2至4周无需干预即可实现良好引流。2例患者分别在术后3周和6周需要通过术中放置的肾造瘘管进行经皮球囊扩张吻合口。其余1例患者经皮扩张失败，肾盂成形术后9周需要进行输尿管肾盂造口术。对整个33例儿童组的长期随访平均为30个月，84%的病例采用放射性核素利尿肾图检查，其余病例采用静脉肾盂造影检查。通过将术后检查结果与术前获得的基线检查结果进行比较评估，所有患者的长期预后均良好。我们的结果表明，肾盂成形术后新重建的吻合口最初引流不畅甚至无引流的肾脏可以挽救，其长期预后与最初引流良好的组相当。此外，最初有功能损害的肾单位中只有43%需要干预，术中放置的肾造瘘管方便了干预。我们建议在肾盂成形术后4至6周进行经皮扩张，因为等待期足够长，可让其自发改善，同时如果引流未发生也不排除成功的结果。输尿管肾盂造口术很少需要。
