目的 探讨重复肾合并肾积水与肾上极较大囊肿的鉴别诊断.方法 分析2005年1月-2010年4月我院收治外院将重复肾合并肾积水误诊为肾囊肿的4例患者的影像学资料、实验室检查结果,并对相关文献进行复习.结果 本组4例患者均于外院诊断为肾囊肿,1例转入我院后行逆行造影时发现输尿管口数目异常,明确诊断,给予膀胱输尿管移植后治愈;1例入院后行CT成像示右肾重复肾、巨输尿管症,给予腹腔镜重复肾上半肾及巨输尿管切除术后治愈;另外2例于外院行腹腔镜"囊肿去顶减压术"后引流液较多,不能拔出引流管而来我院就诊,经检查确诊为重复肾,其中1例行重复肾上半肾切除,另外1例行膀胱输尿管移植后治愈.结论 对于重复肾合并肾积水的患者,术前除应做详细的实验室检查外,必要时行输尿管镜、逆行造影等有创检查,以明确诊断,避免盲目手术造成的严重后果.%Objective To investigate the differential diagnosis between duplex kidney with hydronephrosis and large renal cysts. Methods Imaging data and laboratory data of 4 cases of duplex kidney complicated with hydronephrosis treated by our hospital between January 2005 and April 2010 who had been misdiagnosed as renal cysts by other hospitals were analyzed. Relevant literatures were reviewed. Results All 4 patients studied were misdiagnosed as renal cysts by other hospitals. One case was diagnosed by retrograde contrast after abnormal number of ureteral orifices was noted; the patient was cured after vesico-ureteral transplantation. One other case was descrihed by CT imaging as " duplicated right kidney" with megaureter and was cured by laparoscopic heminephroureterectomy ; the other two cases were hospitalized because of unstoppable drainage after laparoscopic "cyst decortication " performed by other hospitals and were cured by upper pole partial nephrectomy and transplantation of ureter respectively after diagnosed as duplex kidney. Conclusion Aside from detailed routine laboratory examinations, invasive examinations such as preoperative ureteroscopy and antegrade pyelography are more often than not necessary so as to avoid the serious consequences of boldness operations with inadequate consideration.
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