1歲以下嬰兒原發(fā)性梗阻性巨輸尿管合并嚴(yán)重腎輸尿管積水的I期治療：輸尿管皮膚造口

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Stage- I treatment of primary obstructive megaureter with severe hydroureteronephrosis in infants under 1 year old：loop cutaneous ureterostomy

WANG Zhiwei，ZHANG Huangchenghao，YAO Guiping，LI Qiurong，ZHANG Dewei， YAN Bing （Department of Urology，Kunming Children's Hospital，Kunming 65O103，China）

ABSTRACT：ObjectiveTo evaluate the eficacy and prognosis of loop cutaneous ureterostomy（LCU）in the treatment of primary obstructive megaureter（POM）with severe hydroureteronephrosis （HUN）in infants under l year of age，so as to providereference forinfants unsuitable for stage-Iureteralreimplantation.MethodsAretrospective analysis wasconducted onl2 infants with POMand severe HUN treated with LCU inour hospital during Jan.2O19and Dec.2O23.The clinical characteristics，surgical techniques，indications，postoperativecomplications，stage-Isurgical approaches，andfollow-up outcomes were summarized.ResultsAll operations were successful， with an average operation time of （37.08±7.53 ）min （6 left-sided LCU and 6 right-sided LCU） .During the mean follow-up of （10，12±2，70） ）months，all infants showed clinical improvement，with completeresolutionorsignificant alleviationof hydronephrosis，reduced ureteral diameter，and increased renal cortical thickness.Complications included asymptomatic bacteriuria in 3 cases （25% ）and urinary tract infection（UTI） in 1case，allresolved withoralantibiotics.Fourcases developedperistomalrashes，whichimprovedwith topical treatment.Eleven infants underwent stage- I Cohen ureterovesical reimplantation at a mean age of （15，20±2，07 ）months.Notably， 27.3% （204號 （3/11）required ureteraltailoringorplicationduringreimplantation，whichreducedtheriskof ischemic necrosis fromexesive trimming.During the follow-up of （22.17±13.93 ）months，hydronephrosis and renal function improved，and no febrile UTI or bladder dysfunction occurrd.ConclusionLCU isa safe and effective method，which can provide adequate urinary drainage， relieve ostruction，stabilizerenalfunction，andalowtime for ureteral maturationandrenal parenchymal recovery.LCUalso facilitates subsequent stage- I surgery by reducing ureteral dilation.

KEY WORDS： loop cutaneous ureterostomy; primary obstructive megaureter; hydroureteronephrosis; Cohen ureterovesical reimplantation;urinary tract infection;urosepsis;cutaneous ureterostomy

摘要：目的探討采用輸尿管攀皮膚造口術(shù)（LCU）治療1歲以下嬰兒原發(fā)性梗阻性巨輸尿管（POM）合并嚴(yán)重腎輸尿管積水（HUN）的療效及預(yù)后，為不適合I期輸尿管再植的嬰兒提供手術(shù)治療參考。（剩余9681字）