摘要
目的探讨先天性肾盂输尿管连接部梗阻(UPJO)型肾积水患儿肾盂成形术后肾脏形态及功能的可恢复性,并分析可能影响肾功能恢复的相关术前因素。方法 UPJO型肾积水患儿46例,行肾盂成形术患儿手术前后均依据胎儿泌尿外科学会(SFU)分级系统将积水程度进行分级,并行肾核素扫描,测定手术前后受累肾脏分肾功能(DRF)。回顾性调查46例先天性UPJO患儿的临床资料,通过分析以上2种检查手段所获得的数据分析肾脏形态及功能恢复状况,同时应用直线相关分析及双尾t检验分析可能影响术后肾功能恢复的术前因素。结果 SFU分级为2级患儿的术前DRF均在40%以上,分级为3级中的6例(46.2%)和4级中的12例(54.5%)术前DRF均在40%以下;术后积水肾形态改善明显,仅1例仍维持为4级。术后较术前DRF有显著改善(P=0.001)。依据SFU分级或术前DRF,将38例单侧肾积水患儿分组比较,发现当SFU分级为4级或DRF<40%时,术后肾积水程度改善更为显著。术前DRF与手术前后DRF差值呈负相关(r=-0.69,P=0.004)。结论多数行肾盂成形术的患儿,尤其是术前SFU分级为4级和术前DRF<40%者,术后患侧肾脏积水程度显著改善。肾积水程度的SFU分级和患侧肾脏的DRF是决定手术处理方式和术后随访的重要指标。
Objective To explore the recoverability of renal morphology and function after pyeloplasty to relieve congenital ureteropelvic junction obstruction （UPJO）and analyze the associated preoperative factors potentially influencing the outcome of renal function potentially. Methods Forty - six children with UPJO were performed pyeloplasty. Each affected kidney was graded according to the grading system of the Society for Fetal Urology （SFU） on ultrasonography and 99Tc~ -diethynetriaminetaacetic acid renal scan was performed to evaluate the renal function. A total of 46 children with congenital UPJO treated with dismembered pyeloplasty were retrospectively reviewed before and after sur- gery. The recovery of renal morphology and function was examined by analyzing the data collected. Prognostic factors affecting the outcome of the surgical operation were assessed. Results The differential renal function（DRF） of the patients with preoperative SFU grade 2 hydrone- phrosis was above 40% ,and 6 cases（46.2% ） of 13 cases with SFU grade 3 and 12 cases（54.5% ） of 22 cases with SFU grade 4 were below 40% in DRF,respectively. Renal morphology after pyeloplasty improved significantly according to the SFU grading system. Only 1 case remained in grade 4. Furthermore ,renal function of the affected kidney improved significantly after surgery（ P = 0. 001 ）. When the renal units classified based on SFU grading system preoperatively, most significant improvement in the severity of hydronephrosis was observed in patients with grade 4 hydronephoris and （or） preoperative DRF 〈 40%. There was significantly negative correlation between preoperative DRF and the pre - and post - operative renal function difference （ r = - 0.69,P = 0. 004）. Conclusions Improvement in the severity of hydronephrosis in the affected kidney may be markedly in most of patients after a successful pyeloplasty especially when DRF 〈40% or as grade 4. SFU grading system and DRF are of practical use in the adoption of the treatment and
出处
《实用儿科临床杂志》
CAS
CSCD
北大核心
2010年第23期1793-1795,共3页
Journal of Applied Clinical Pediatrics
