点击显示 收起
摘 要：目的 探讨肾重复畸形病理改变及与影像所见、手术之间关系。方法 对128例手术治疗病例术中进行观察，描述肾、输尿管的解剖改变，对比超声、IVU、SPECT检查结果。结果 重肾多位于上肾段，占96.8%，与下肾段为一体，共处在一个脂肪囊内，有各自的肾盏、肾盂等集合系统，重肾外观分为发育型、积水型和发育不良三型，支配重肾的血管分支少。两条输尿管下行在一个鞘内，其间有一条动、静脉，共同支配其血运。重复输尿管外观粗大、苍白、蠕动无力，绕下输尿管走行；49例输尿管末端合并囊肿，26例合并输尿管异位开口。结论 肾重复畸形的病理解剖改变有规律性，明确其解剖变异对提高确诊率和选择治疗方案均有重要意义。
Anatomical changes of duplicate kidney and its significance
WANG Changlin
（Department of Pediatric Surgery, the Second Clinical College, China Medical University,Shenyang 110003,China）
WANG Xiangang
（Department of Pediatric Surgery, the Second Clinical College, China Medical University,Shenyang 110003,China）
ZHAO Guogui
（Department of Pediatric Surgery, the Second Clinical College, China Medical University,Shenyang 110003,China）
Abstract：Objective To clarify the relationship between the anatomical changes and imaging.Ope-rative findings in duplicate kidney.Methods The anatomical changes of the duplicate kidney and ureter were observed during operation in 128 cases.The anatomical changes were correlated with the ultrasonography, IVU and SPECT findings.Results Most of the duplicate kidney was located at the upper renal segment (96.8%) confusing with the lower segment both of which being in the same fatty capsule.The two had separated calyses and pelvis.From the gross appearance, duplicate kidney could be classified into developed type, the hydronephrosis type and the dysplasia type.The blood supplying of the duplicate kidney was less.The 2 ureters were in the same fascial compartment with an artery and a vein.The duplicate ureter looked thick and pale and its peristalsis feeble.The upper ureter was usually circumventing the lower one.49 cases were complicated by ureterocele and 26 by an ectopic ureteral orifice.Conclusions Anatomical changes of duplicate kidney are usually of regular patterns.Making the variations clear is of great importance in improving the diagnosis accuracy and in choosing the treatment strategy.
Key words：Kidney Abnormalities Pathology▲
我们对10余年来手术治疗的128例肾重复畸形(重肾)，进行病理解剖学观察，探讨其与影像学之间的关系，选择治疗方案。报告如下。
资料和方法
1985～1998年收治肾重复畸形146例，其中手术治疗128例，男17例，女111例。年龄2个月～14岁， 其中＜1岁者25例，1岁～28例，4岁～48例，8～14岁27例。左侧重肾63例，右侧51例，双侧14例。合并有输尿管囊肿49例（双侧2例），输尿管异位开口26例（双侧1例），术前全部行彩超、IVU检查，28例经膀胱造影，24例行SPECT检查，8例行CT检查，4例行MRI检查。18例非手术治疗，128例行手术治疗。术式：重肾及输尿管切除122例(同时经膀胱行输尿管囊肿切除24例)，单纯输尿管膀胱内移植术3例，经尿道外口行囊肿去顶术4例。对16例重肾组织及18例切除重复输尿管进行了病理观察。
结 果
一、重肾的位置
重肾位于上肾段者124例(96.8％)，下肾段者2例，不能判定者2例（两肾段均为发育不良肾）。重肾与下肾段外观融为一体，共在一个脂肪囊内，两肾实质相连，但表面有一浅沟为界，其内有各自的肾盏、肾盂等集合系统。两肾的血运来自一个肾蒂，多数血管进入下肾段，仅在靠近肾实质处可见1～2个分支进入重肾。