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目的探讨成人先天性巨输尿管症的诊断和治疗方法。方法对30例先天性巨输尿管症患者均行B超检查和膀胱镜下逆行插管后逆行造影(RP)+膀胱造影,其中行静脉尿路造影(IVU)22例,CT检查16例。30例患者行一期输尿管膀胱吻合术24例;先行肾造瘘,二期行输尿管膀胱吻合术4例,因肾重度积水,功能严重受损而行肾输尿管切除术2例。结果B超、CT和IVU均显示患侧输尿管扩张伴肾积水,RP+膀胱造影既显示患侧输尿管扩张伴肾积水,又排除输尿管末端机械性狭窄、膀胱输尿管返流。28例行输尿管裁剪加抗逆流输尿管膀胱再植术,疗效满意。结论B超是诊断该病的主要筛选手段,逆行尿路造影是该病的主要确诊手段。输尿管裁剪加抗逆流输尿管膀胱吻合术仍是治疗该病的主要方法。
Objective To investigate the diagnosis and treatment of adult giant ureteral diseases. Methods Thirty patients with congenital giant ureteral disease underwent both B-mode ultrasound and retrograde retrograde cystoscopy retrograde angiography (RP) + cystography, including 22 cases of IVU and 16 cases of CT. Thirty patients underwent a ureteric anastomosis in 24 cases. Renal ostomy was performed in the second stage, and ureteric anastomosis in the second stage was performed in 4 cases. Nephroureterectomy was performed in 2 cases due to severe hydronephrosis and impaired function. Results B ultrasound, CT and IVU showed ipsilateral ureteral dilatation with hydronephrosis, RP + cystography showed both ipsilateral ureteral dilatation and hydronephrosis, and ruled out the distal ureteral mechanical stenosis, vesicoureteral reflux. 28 cases of ureteral incision and anti-reflux ureter bladder replantation, with satisfactory results. Conclusion B ultrasound is the main screening method for the diagnosis of the disease. Retrograde urography is the main diagnostic method of the disease. Ureterography and anti-reflux ureter anastomosis is still the main method of treatment of the disease.