肾外伤后输尿管肾盂连接处完全断裂:保守治疗。

M B Oliver Vall-Llosera, R Gander, G Royo Gomes, M Aguilera Pujabet, O Rocha Guzmán, M López Paredes, M Asensio Lorente
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引用次数: 0

摘要

简介:许多学者仍建议对完全性输尿管肾盂连接中断(CUPJD)进行手术探查。小儿肾创伤(RT)的保守治疗方法包括肾造瘘术、血管栓塞术或双J支架置入术等微创技术:病例报告:一名 14 岁的 CUPJD 患者接受了保守治疗。CT 扫描显示肾动脉有活动性出血和明显的尿液外渗。患者接受了盘状血管栓塞术和肾造瘘术。尝试放置双J支架未果,于是安排了手术重建。手术前,通过肾造口术注入亚甲基蓝,观察到蓝色尿液通过尿道排出。前行肾盂造影显示尿瘤向输尿管引流。再次尝试放置内外双 J 型支架获得成功。5 周后,支架被移除,尿路完全恢复:结论:通过非手术方法,可以使一些接受 RT 治疗的 CUPJD 病例的尿路完全恢复。结论:对于某些接受 RT 治疗的 CUPJD 病例,可以通过非手术方法完全恢复尿路功能,这种方法既安全又有效,还能降低复杂手术带来的并发症风险。
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Complete ureteropelvic-junction disruption following renal trauma: conservative management.

Introduction: Surgical exploration in complete ureteropelvic-junction disruption (CUPJD) is still recommended by many authors. Conservative approach to pediatric renal trauma (RT) includes minimally invasive techniques such as nephrostomy, angioembolization or double-J stent placement.

Case report: A 14-year-old patient with CUPJD was treated conservatively. CT-scan revealed active bleeding of the renal artery and significant urine extravasation. Coil angioembolization and nephrostomy placement were performed. An attempt to place a double-J stent was unsuccessful and surgical reconstruction was scheduled. Before surgery, methylene-blue was injected through the nephrostomy observing blue urine output through urethra. Antegrade pyelogram revealed drainage from the urinoma to the ureter. A new attempt to place an internal-external double-J-stent was successful. After 5 weeks, it was removed with total restoration of the urinary tract.

Conclusion: Complete urinary tract restoration in some cases of CUPJD following RT is possible through a nonoperative approach. It can be safe and effective, reducing the risk of complications associated with complex surgeries.

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