上部尿路通過障害 : 乳幼児期の先天性水腎症の診断と治療

Abstract

2歳未満の先天性水腎症29例の臨床的検討を行い, また乳幼児期先天性水腎症の診断と治療において問題提起する代表的症例を提示し, 診断と治療法について述べた.1) UPJ狭窄の部位や程度ならびに機能が症例によって異なること, また乳幼児では身体が発育し, 発達することを考慮に入れて手術の適応を決めるべきと考えられた.2)腎保存か否かの判定に造影後CTスキャンとMRIのT1強調画像が有用であった.3) Anderson-Hynes法による手術成績は良好であったが, 手術侵襲が少ない内視鏡手術の発展が期待される

Twenty nine children under 2 years old with congenital hydronephrosis have been treated in the last 14 years in our department. We report 4 cases which we found difficult to diagnose and treat. The diagnosis and the treatment of congenital hydronephrosis in children are discussed, especially concerning those patients under the age of 2 years. Pyeloplasty has been performed in 28 renal units out of 35 renal units. The results of the procedure were good in 82.1%, fair in 10.7%, no change in 3.6% and a lost case in 3.6%. The Aderson-Hynes dismembered technic was employed except for one renal unit in which the extrarenal pelvis was resected. Hydronephrosis in two renal units and one with nephrostomy for one year and one month improved spontaneously. Endopyelotomy was performed in 2 renal units and will be performed in one renal unit. Nephrectomy was carried out in one renal unit with renal dysplasia. A kidney with dysplasia excreted urine of several ml/day. Post-enhanced-X-ray computed tomography and T1-weighted image of magnetic resonance presented loss of function in the kidney. Degree of stenosis, position of stenosis and function of pelvis and ureter were different in each child. Children are constantly growing up and the condition of stenosis was changed in some cases. In conclusion, we should estimate the stenosis in children using several examinations.