수신증에 대한 임상적 관찰

Abstract

[한글]

1965년 1월부터 1975년 12월까지 11년간 본 비뇨기과에서 경험한 수신증환자 131예에

대한 임상적 관찰 및 문헌을 고찰하였다.

1) 동기간중 입원환자는 2995명으로써 수신증환자는 4.3%를 차지하고 있었다.

2) 발생연령을 보면 전연령에 분포되어 있으나 30세이상에서 49세 미만까지가 가장 많

아 45.8%를 차지하고 있었으며 성별은 여자가 남자보다 1.3배 많았다.

3) 병변부위는 좌측이 우측보다 1.2배 많았으며 양측성인 경우도 15예(11.5%)를 차지하

고 있었다.

4) 원인적 요소는 후천적 요소인 요관협착이 46예로써 가장 많았고 다음이 결석에 의한

것이 26예 였으며, 선천성 요관신우이행부협착도 21예로서 16%이였다. 소아에서 선천성

수신증 16예중 7예가 요관신우이행부협착으로써 43.75%를 차지하였다. 요관협착 46예중 1

7예가 과거의 수술로 인한 것이였다.

5) 입원당시의 주소로써는 측복부 동통이 54.96%로써 제일 많았다.

6) 검사소견을 보면 BUN이 20mg% 이상 증가한 예가 18예로써 13.7% 이였고 Creatinine

치는 2.0mg%이상 증가한 예가 15예로써 11.5%이였다. 요검사에서 농뇨가 61예로써 46.6%

이였고 45예에서 균배양검사를 하였는데 그중 15예에서 E. Coli가 검출되었다.

7) 내시경 검사를 한 109예중 37.4%인 49예에서 정상소견을 보였으며 22.9%에서 방광염

증소견을 보여주었다.

8) 131예에서 비수술적 조작 28예를 제외하고 121예의 수술적 치료를 시행하였다. 신적

출술 및 신뇨관적출술이 49예로써 40.49%를 차지하였는데 1965년부터 1970년까지가 27예

로써 1971년부터 1975년까지의 22예보다 5예가 많았다. 특히 선천성요관 신우이행부협착

21예중 1965년부터 1970년까지 12예였는데 그중 8예에서 신적출술을 하여 66.6%를 나타냈

으나 1971년부터 1975년까지의 9예에서는 5예에서 신적출술을 하여 55.5%를 나타내서 최

근 수년간에는 신장을 보존하는 치료법으로 기울고 있음을 알 수 있다. 그의 요로전환술

이 23예로써 19%였고 요관방광조구술이 10예로써 8.3%를 차지하고 있었다.

[영문]

Hydronephrosis is a dilatation of the collecting system of the kidney caused by

obstruction to the flow of urine.

Almost any type of urinary tract abnormality which leads to obstructive uropathy

can eventually result in hydronephrosis; depending on the site of obstruction, the

hydronephrosis may be bilateral or unilateral.

If no infection is present, the dilatation of the collecting system can be of

little or no clinical significance until compression and atrophy of the renal

parenchyma occur. Asymptomatic or silent hydronephrosis of a lesser degree is often

found in adults.

Either the hydronephrotic kidney should be removed or the obstructive outlet

repaired depending upon the degree of compensatory hypertrophy in the contralateral

kidney. Recently, a tendency to preservation of the hydronephrotic kidney is

increased by the urologist.

A clinical observation was made on 131 cases of hydronephrosis during 11 years

from January, 1965 to December, 1975.

The results are as follows:

1. There rate of hydronephrosis accounted for 4.3% of the total patients (2995

cases) admitted to the Department of Urology.

2. The patients in this series were distributed over all ages from 6 months old

female baby to 76 years old female patients.

The most common age group was the 4th decades (26%).

The male and female ratio was 1:1.2.

3. In the affected site, there was more in the left side than the right 1.2

times. 15 cases (11.5%) were bilateral.

4. In etiology, acquired ureteral stricture was most common by 46 cases (35%) and

congenital UPJ stenosis was 21 cases (16%) and etc. In children of congenital

hydronephrosis (16 cases), congenital UPJ stenosis was 7 cases (43.8%) and the male

and female ratio was 1.7:1. In 46 cases of acquired ureteral stricture, 17 cases

(37%) were due to previous operations (almost gynecologic operations in pelvic

malignancies).

5. The symptoms on admission were flank pain in 72 cases (55%), hematuria 25

cases (19%) and etc.

6. Pyuria in urinalysis was found in 61 cases (46.6%). Urine culture was

performed in 45 cases and E. coli was detected in 15 cases (33%). B.U.N. was

elevated in 18 cases (13.7%) and creatinine 15 cases (11.5%).

7. Cystoscopy was performed in 109 cases. Abnormal cystoscopic findings were seen

in 60 cases (55%).

8. 121 operations were performed in 103 of 131 patients.

Nephrectomy and nephroureterctomy were 49 cases (40.5%) and urinary diversion 23

cases (19%) and ureteroneocystostomy 10 cases (8.3%) and etc. In 49 cases of

nephrectomy and nephroureterectomy, 27 cases were done from January, 1965 to

December, 1975.

In 21 cases of congenital UPJ stenosis, 8 of 12 cases (66.6%) were nephrectomised

from January, 1965 to December, 1970 and 5 of 9 cases (55.5%) were nephrectomised

from January, 1965 to December, 1975.