婴儿肾盂输尿管交界处梗阻致自发性肾盂破裂的诊断与治疗

Q4 Medicine

中华泌尿外科杂志 Pub Date : 2019-09-15 DOI:10.3760/CMA.J.ISSN.1000-6702.2019.09.011

B. Guo

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Other symptoms included fever in 4 cases, digestive symptoms in 3 cases, oliguria in 2. 7 cases were revealed RBC(+ + + )with urinary occult blood positive in urine test. 6 cases were found the white blood cells in urine was more than 8/μl. 3 cases had the elevated blood C-reactive protein.3 cases suffered with renal function insufficiency, which the creatinine was more than 110 μmol/L. The 2 cases of urinary extravasation was found in the posterior abdominal cavity and 2 in posterior abdominal cavity and abdominal cavity by CT enhanced scan. 4 cases performed open pyeloplasty, nephrostomy and perirenal drainage.2 cases performed pyeloplasty, nephrostomy, abdominal and perirenal drainage. 1 case performed perirenal drainage and retrograde indwelling Double-J stents. \n \n \nResults \nAll operation performed successfully. The median operation time was 84 min (ranging 45-90 min). The estimate blood loss was 15 ml (ranging 10-35 ml)without any transfusion. 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引用次数: 0

摘要

目的分析UPJO致婴儿自发性肾盂破裂的临床特点。方法对我院2013年10月至2018年10月收治的7例UPJO引起的婴幼儿SRRP进行回顾性分析。所有患者包括5名男性和2名女性。平均年龄为（12.0±6.1）个月（2天至25个月）。左侧肾破裂3例，右侧肾破裂4例。Ⅲ级肾积水2例，Ⅳ级肾积水5例。其他症状包括发热4例，消化道症状3例，少尿2例。尿路潜血阳性7例，RBC（+++）阳性。6例尿白细胞含量大于8/μl。血C反应蛋白升高3例，肾功能不全3例，肌酐大于110μmol/L。CT增强扫描发现2例尿外渗发生在后腹腔，2例发生在后腹膜和腹腔。4例行开放性肾盂成形术、肾造口术和肾周引流术，2例行肾盂成形术，肾造口术，腹部和肾周排水术。1例患者行肾周引流并逆行留置双J支架。结果全部手术成功。中位手术时间为84分钟（45-90分钟）。在没有任何输血的情况下，估计失血量为15毫升（范围为10-35毫升）。术后肾周引流管的中位时间为3天（2-5天），腹部引流管的中位数时间为5天（3-7天），肾造口术的中位数时间是12天（10-14天）。中位住院时间为14天（10-21天）。中位随访时间为18个月（3-36个月）。其中一例在取出双J支架后进行了第二期肾盂成形术，肾功能逐渐恢复。结论UPJO引起的婴幼儿SRRP罕见，易误诊。肾积水和炎症程度可能是影响儿童肾盂自发性破裂的重要因素。当它发生时，需要手术积极干预，同时治疗UPJ狭窄并排出尿液外渗。关键词：肾病；自发性肾盂破裂；肾盂输尿管交界处梗阻

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Diagnosis and treatment of spontaneous rupture of renal pelvis caused by pelviureteric junction obstruction in infants

Objective To analyze the clinical features of spontaneous rupture of the renal pelvis (SRRP) in infants caused by UPJO. Methods A retrospective analysis of 7 cases of SRRP in infants caused by UPJO in our hospital from October 2013 to October 2018 was performed. All the patients included 5 males and 2 females. The average age was(12.0±6.1) months(ranging 2 days-25 months). 3 cases suffered renal rupture in left side and 4 cases suffered renal rupture in right side. 2 cases had grade Ⅲ hydronephrosis and 5 cases had grade Ⅳ hydronephrosis. Other symptoms included fever in 4 cases, digestive symptoms in 3 cases, oliguria in 2. 7 cases were revealed RBC(+ + + )with urinary occult blood positive in urine test. 6 cases were found the white blood cells in urine was more than 8/μl. 3 cases had the elevated blood C-reactive protein.3 cases suffered with renal function insufficiency, which the creatinine was more than 110 μmol/L. The 2 cases of urinary extravasation was found in the posterior abdominal cavity and 2 in posterior abdominal cavity and abdominal cavity by CT enhanced scan. 4 cases performed open pyeloplasty, nephrostomy and perirenal drainage.2 cases performed pyeloplasty, nephrostomy, abdominal and perirenal drainage. 1 case performed perirenal drainage and retrograde indwelling Double-J stents. Results All operation performed successfully. The median operation time was 84 min (ranging 45-90 min). The estimate blood loss was 15 ml (ranging 10-35 ml)without any transfusion. The median time of postoperative perirenal drainage tube was 3 d (ranging 2-5 d), The median time of the abdominal drainage tube was 5 d (ranging 3-7 d), the median time of nephrostomy was 12 d (ranging 10-14 d). The median hospital stay was 14 d (ranging 10-21 d). The median follow-up was 18 months (ranging 3-36 months). One performed the second stage pyeloplasty after double-J stents removed, and the renal function gradually recovered. Conclusions The SRRP in infants caused by UPJO is rare and easily misdiagnosed. The degree of hydronephrosis and inflammation may be important factors affecting the spontaneous rupture of pediatric renal pelvis. When it occurs, it requires active intervention by the operation, while treating the stenosis of the UPJ and draining the extravasation of urine. Key words: Hydronephrosis; Spontaneous rupture of the renal pelvis; Ureteropelvic junction obstruction

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来源期刊

中华泌尿外科杂志 Medicine-Nephrology

CiteScore

0.10

自引率

0.00%

发文量

14180

期刊介绍： Chinese Journal of Urology (monthly) was founded in 1980. It is a publicly issued academic journal supervised by the China Association for Science and Technology and sponsored by the Chinese Medical Association. It mainly publishes original research papers, reviews and comments in this field. This journal mainly reports on the latest scientific research results and clinical diagnosis and treatment experience in the professional field of urology at home and abroad, as well as basic theoretical research results closely related to clinical practice. The journal has columns such as treatises, abstracts of treatises, experimental studies, case reports, experience exchanges, reviews, reviews, lectures, etc. Chinese Journal of Urology has been included in well-known databases such as Peking University Journal (Chinese Journal of Humanities and Social Sciences), CSCD Chinese Science Citation Database Source Journal (including extended version), and also included in American Chemical Abstracts (CA). The journal has been rated as a quality journal by the Association for Science and Technology and as an excellent journal by the Chinese Medical Association.