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中華民國泌尿科醫學會雜誌

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篇名 Pyeloplasty on Children of Ureteropelvic Junction Obstruction
卷期 2:4
並列篇名 以腎盂成形手術治療小兒腎盂輸尿管移形部阻塞
作者 洪正昇孟繁蕃謝從賓
頁次 613-619
關鍵字 ureteropelvic junction obstructionpyeloplastyhydronephrosisTSCI
出刊日期 199112

中文摘要

自民國76年至78年2年間共有36個病人(37個腎臟)接受腎盂成形手術。這些大部份是兒童與嬰兒經超音波篩檢而發現水腎, 並進一步診斷確定為腎盂輸尿管移形部阻塞的病人。病人有時發生類似胃腸障礙之腹痛外,無其他自覺症狀。診斷上除了超音波對整個泌尿系統做詳細檢查外,還做了靜脈注射腎盂攝影術、注的影利術、膀胱排尿攝影術及於放射性同位素腎臟造影術,注射利尿劑算出腎盂之尿排空一半所須時間。手術後,以超音波追蹤一年以上。95%腎盂皆獲得改善而縮小。但以腎盂之尿排空一半所須時間追蹤24個腎臟時,只有78%恢復到10分鐘以內。所有手術都是切除阻塞病份再度接合腎盂與輸尿管。初期18個病人(甲組)都置有腎臟造管及作為接合處支架的輸尿管導管。後期18個病人(乙組)都沒有放腎造管及輸尿管支架。甲組病人平均住院日為19天,13人發生併發症,以尿路感染最多,乙組病人為11天,5人發生併發症,長期追蹤,以超音波來看腎盂的大小1公分以下的在甲組有15個腎臟,在乙組只有4個腎臟。以腎盂之尿排空一半所時間來看,10分鐘以內的在甲組14個腎臟中有12個,在乙組10個腎臟中只有5個。腎盂形成手術時放不放腎臟造管及輸尿管支架一直是個爭議點。在本報告中,不放管子的乙組住院日短,病發症少,一樣不易漏尿。初期似乎優於甲組。但長期追蹤後發現放管子的甲組,其腎盂的大小以及腎盂之尿排空一半所須時間回復到正常的較多,看來是比乙組好。治療腎盂輸尿管移形部阻塞的方法有許多種,但都有一共同盲點就是我們只改善了尿路阻塞的情形,改善了腎盂及腎臟本身的大小,但對於阻止腎功能的惡化卻無法有正確的評估。此外有一些期刊報告指出有少數腎盂輸尿管移形部阻塞的病例發生自然痊癒的現象,特別是新生兒較兒童多。我們也有三例新生兒診斷確定為腎盂輸尿管移形部阻塞的病人未經手術治療卻自然痊癒。因此我們認為此疾病之診斷及治療應趨向保守。

英文摘要

36 cases (37 kidneys) received dismembered pyeloplasty for ureteropelvic junction obstruction. All cases were school children and new born babies that were screened with ultrasound for hydronephrosis. 99mTc DTPA diruretic renal scanning with wash out half time (T1/2) was used in evaluation of obstruction. The first 19 pyeloplasties (group A) were done without nephrostomy tube nor ureteral splint. The later 18 pyeloplasties (group B) were done without nephrostomy tube nor ureteral splint. The averago admission days were 19.4 days for group A and 11.6 days for group B. UTI complication was noted in 11 kidneys (57%) of group A and in 2 kindeys (11%) of group B. Group A had longer admission days and more complications at the beginning. But after long term follow up group A had shorter T1/2 and smaller renal pelvic A-P diameter. Totally 35 kidneys (95%) had their hydronephrosis improved.

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