【作者】 范本祎； 齐琳； 陈湘； 齐范； 申鹏飞； 刘立宇； 周密；

【Author】 Ben-Yi Fan Li-Yu Liu Lin-Qi Xiang Chen Fan-Qi Peng-fei Shen Mi Zhou Department of Urology, Xiang-Ya Hospital of Central South University Changsha 410008

【机构】 中南大学湘雅医院泌尿外科；

【摘要】 目的:下腔静脉后输尿管是儿童较少见的畸形,是由于下腔静脉发育异常致右输尿管绕行下腔静脉的后侧,而导致输尿管不全梗阻。本文旨在提高儿童下腔静脉后输尿管的诊治水平。方法:对我回顾性分析2002-2006年我院诊治的6例下腔静脉后输尿管患儿的临床资料。6例患儿均行逆行输尿管造影(RU)或多层螺旋CT三维尿路成像(MSCTU)等检查,特征性影象学表现为输尿管呈倒J形或S形;治疗采用微创的腹膜后途径腹腔镜下输尿管矫正复位术,术中将输尿管切断移到下腔静脉前做输尿管端端吻合术。结果:6例患儿均术前确诊。术后3～6个月复查症状消失,B超和IVU示肾积水有不同程度减轻。微创的腹膜后途径腹腔镜下输尿管矫正复位术同传统开放手术相比并不增加手术并发症。结论:IVU和RU是诊断下腔静脉后输尿管的首选方法;MSCTU是诊断下腔静脉后输尿管最佳的无创性检查方法。输尿管切断复位矫正术是治疗此病较好的手术方法,而腹腔镜治疗腔静脉后输尿管创伤小、美观、恢复快,效果满意,是腔静脉后输尿管有效的微创治疗新手段。更多还原

【Abstract】 Objective :To improve the levels of diagnosis and treatment for retrocaval ureter. Method: The clinical data of 6 padatrics with retrocaval ureter were retrospectively analyzed in our hospital from 2002 to 2006. All the cases were diagnosed depends on retrograde uretergraph (RU) and multi-slice computed tomography urography (MSCTU). An "S" or "fish hook" deformity was present at the place of obstruction ureter. Orthopedics and reduction were performed for these children cut off the ureter and was shifted to front of inferior cava vein and then ureter was end- to- end anastomosed then it was placed to its normal anatomic position. Result: All the 6 cases were correctly diagnosed preoperatively. The symptom disappeared in all cases with hydronephrosis and hydroureter significantly reduced on B ultrasonography and intravenous urography(IVP) , and no ureter stenosis was observed postoperatively. Compared to open surgery, Ureteral replacement and ureteroplasty by retroperitoneal laparoscopic technology were used to treat this disease. Conclusion: Intravenous urography(IVP) and Retrograde ureteropyelography (RP) are the first choices for the diagnosis of retrocaval ureter. MSCTU is the most efficacious and least invasive method to confirm the retrocaval ureter. Compared with open surgery, laparoscopic surgery is a minimally invasive, safe and effective therapy and is the first choice of surgical techniques for retrocaval ureter.更多还原