Retrocaval Ureter: Report of 12 Cases and Literature Review

下腔靜脈後輸尿管－病例整理及文獻回顧

黃國皓(Kuo-How Huang) ； 張效駿(Shiou-Chun Chang) ； 闕士傑(Shih-Chieh Chueh) ； 黃昭淵(Chao-Yuan Huang) ； 蒲永孝(Yeong-Shiau Pu) ； 陳淳(Jun Chen)

《臺灣泌尿科醫學會雜誌》 16卷4期 (2005/12) Pp. 163-168

摘要

研究目的：下腔靜脈後輸尿管為一罕見之先天性血管發育異常，為提高其診斷與治療的水準，我們整理臨床上的病例，並討論目前較新的診斷與治療方式。
材料與方法：藉由病歷資料，分析台大醫院十五年來共十二位下腔靜脈後輸尿管的病例，其臨床表現、診斷、治療、及追蹤的結果，並回顧文獻資料。
結果：有三位病例有合併異常(25%)，臨床症狀以右側腰痛(75%)最常見。在術前有十一位病患能以影像檢查做出正確的診斷(91.7%)。十一位接受了開腹式輸尿管狹窄處切除及輸尿管重新接合。一位接受腹腔鏡手術。術後6個月，所有病人腎及輸尿管上段水腫均明顯改善，輸尿管通暢，吻合處無狹窄，獲得良好的結果(100%)。
結論：下腔靜脈後輸尿管術前，大多可以影像學檢查做出正確診斷，狹窄處輸尿管切除並重新吻合，是治療下腔靜脈後輸尿管的主要方式，腹腔鏡手術具有術後傷口疼痛較少，恢復快的優點，可達到與傳統手術相同的效果，是未來治療的趨勢。

關鍵字

下腔靜脈後輸尿管 ； 輸尿管重新吻合

並列摘要

OBJECTIVE: Retrocaval ureter is a rare congenital anomaly. For clarification of clinical presentations, radiological features, diagnosis, and treatment outcomes, we retrospectively reviewed 12 cases in our hospital.
MATERIALS AND METHODS: From January 1989 to December 2004, 12 cases with retrocaval ureter were treated in our hospital. Their medical records were analyzed, and the relevant literature was reviewed.
RESULTS: Among the 12 cases, there were 11 males and 1 female aged 15~71 (mean, 32.3) years. The main clinical features included flank pain in 9 cases (75%) and hematuria in 3 cases (25%). Retrocaval ureter was diagnosed preoperatively by imaging studies in 11 cases (91.7%). All cases received an operation including 1 laparoscopic ureteroureterostomy. Clinical symptoms and hydronephrosis had improved in all patients by 6 months postoperatively.
CONCLUSIONS: An accurate preoperative diagnosis in most cases with retrocaval ureter can be achieved by imaging studies. Surgical treatment can achieve successful results. A laparosopic ureteroureterostomy is minimally invasive with good convalescence and outcome.

並列關鍵字

retrocaval ureter ； ureteroureteral anastamosis ； laparosopic ureteroureterostomy