Analysis of diagnosis and treatment experience in 22 patients with renal duplication
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摘要: 目的 重复肾的治疗方式多种多样,本文通过回顾性分析22例重复肾患者的临床及解剖变异特征和治疗经验,探讨不同类型重复肾患者不同治疗方式的选择及个体化治疗的重要性,以期提高对重复肾治疗的水平。方法 回顾性分析2017年10月—2020年12月就诊于兰州大学第二医院的22例重复肾患者的临床资料,并根据手术方式分组,其中14例患者采用半肾切除术(A组),6例患者采用输尿管膀胱再植术(B组),2例患者采用肾盂输尿管成形术(C组),并总结了每例患者的临床症状、影像学检查、解剖变异特征、治疗方式及预后,分析和探讨个体化的临床特点与治疗方式及预后的关系,阐明个体化治疗的重要性。结果 平均随访时间5.5个月,1例患者失访,3例患者术后症状没有改善遂行二次手术,其余患者术后临床症状消失,手术效果良好。结论 不同的重复肾患者存在不同的解剖学特点,其治疗方式的选择需要根据特异的临床特点、解剖学特点并结合医生的经验,选择最佳的治疗方式会减少患者二次手术的发生率,并可提高治愈率。Abstract: Objective The treatment of renal duplication is various. By retrospective analysis of the clinical and anatomical variation characteristics and treatment of 22 cases of renal duplication, this paper discusses the selection of different treatment methods for different types of renal duplication and the importance of individualized treatment, in order to improve the level of treatment for renal duplication.Methods We retrospectively analyzed the clinical data of 22 cases of renal duplication from October 2017 to December 2020. Among them, 14 patients were treated with heminephrectomy(group A), 6 patients with ureterovesical reimplantation(group B), 2 patients with pyeloplasty(group C). The clinical symptoms, imaging examination and anatomical characteristics of 22 cases of renal duplication were retrospectively summarized to analyze and discuss the relationship between individualized clinical characteristics, treatment methods and prognosis and clarify the importance of individualized treatment.Results The average follow-up time was 5.5 months and one patient was lost in follow-up. Three patients underwent second operation because of no improvement of postoperative symptoms. The clinical symptoms of other patients disappeared.Conclusion The treatment of renal duplication needs to combine the clinical, anatomical characteristics and the experience of doctors to choose individualized operation method to reduce the incidence of secondary surgery and improve the cure rate.
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Key words:
- renal duplication /
- operation method /
- individualized treatment
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表 1 患者的一般临床资料
组别 例数 平均年龄
/岁性别 手术方式 男 女 A组 14 12.8 3 11 半肾切除术 B组 6 6.4 2 4 输尿管膀胱再植术 C组 2 19.0 0 2 肾盂成形术 表 2 A组患者的基本信息及解剖病理特点
序号 年龄/岁 性别 临床症状及解剖病理特点 随访结果 1 50 女 腰部胀痛,右侧完全重复肾并重度积水扩张,肾皮质菲薄 症状消失 2 36 女 腹部胀痛,右侧完全重复肾并重度积水扩张,肾皮质菲薄 症状消失 3 19 男 腰部胀痛,右侧完全重复肾并重度积水扩张,肾皮质菲薄 失访 4 3 女 腹痛并尿路感染,左侧完全性重复肾并输尿管末端囊肿,重度积水,肾皮质菲薄 腹痛间断出现,输尿管末端囊肿存在 5 2 女 腹痛,右侧完全性重复肾并输尿管末端囊肿,重度肾积水,肾皮质菲薄 症状及输尿管末端囊肿消失 6 10 女 腹痛,右侧完全性重复肾,重度肾积水,肾皮质菲薄 症状消失 7 0.5 女 胎检发现肾积水,右侧完全性重复肾并末端囊肿,重度肾积水,肾皮质菲薄 术后彩超正常a) 8 0.6 女 胎检发现肾积水,右侧完全性重复肾并末端囊肿,重度肾积水,肾皮质菲薄 术后彩超正常a) 9 1 男 胎检发现肾积水,左侧完全性重复肾并末端囊肿,重度肾积水,肾皮质菲薄 术后彩超正常a) 10 0.7 女 腹部触及肿物,左侧不完全性重复肾并重度肾积水 术后彩超正常a) 11 2 男 体检发现,右侧不完全性重复肾并重度积水.肾皮质菲薄 术后彩超正常a) 12 3 女 排尿中断,右侧完全性重复肾并重度肾积水,输尿管末端囊肿,肾皮质菲薄 症状消失,术后彩超正常a) 13 18 女 阴道漏尿,完全性重复肾并输尿管异位开口于阴道,重度肾积水 术后出现输尿管残端积脓 14 33 女 腰部疼痛,右侧完全性重复肾并重度肾积水 症状消失 注:a)术后彩超正常指无肾窦分离及输尿管的扩张并膀胱内未见输尿管末端囊肿。 表 3 B组患者的基本信息及解剖病理特点
序号 年龄/岁 性别 临床症状及解剖病理特点 随访结果 1 10 女 外阴部漏尿,右侧完全重复肾并异位开口,轻度肾积水 症状消失,术后彩超正常a) 2 20 女 腰部胀痛,左侧完全性重复肾并输尿管末端狭窄,中度肾积水 症状消失,术后彩超正常a) 3 0.5 男 胎检发现肾积水,右侧完全性重复肾并输尿管末端狭窄,重度肾积水 彩超显示肾积水减轻(6.3至3.5 cm)b) 4 4 男 腹痛,左侧完全性重复肾,重度肾积水 症状消失,肾积水减轻(5.4至2.2 cm)b) 5 1 女 胎检发现肾积水,完全性重复肾并上肾及下肾均积水扩张 上肾积水加重,下肾积水减轻(上肾3.0至6.4 cm,下肾2.4至0.8 cm)b) 6 3 女 漏尿,左侧完全性重复肾并异位开口于尿道 症状消失,术后彩超正常a) 注:a)术后彩超正常指无肾窦分离及输尿管的扩张并膀胱内未见输尿管末端囊肿;b)括号内指经彩超或MRU测量的术前至术后肾窦分离的数值变化。 表 4 C组患者的基本信息及解剖病理特点
序号 年龄/岁 性别 临床症状及解剖病理特点 随访结果 1 28 女 腰部胀痛,左侧上肾中度积水,其肾盂输尿管连接部狭窄,两输尿管于髂血管分叉处汇合 症状消失 2 10 女 体检彩超发现左侧下部肾积水,完全性重复肾并肾盂输尿管连接部狭窄,右侧先天性肾缺如 术后彩超示肾积水减轻(3.5至1.4 cm)a) 注:a)括号内指经彩超或MRU测量的术前至术后肾窦分离的数值变化。 -
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