小儿肾积水手术前后利尿性肾动态显像对比研究  

Comparative study of diuretic renal dynamic imaging in pre- and post-operative pediatric hydrone-phrosis

作　　者：吴哈[1] 赵瑞芳[1] 季志英[1] 吕孝妹[1] 李益卫[1] 顾凡磊[1] 赵晓斐[1] 阮双岁[2] 

机构地区：[1]复旦大学附属儿科医院核医学科,上海200032 [2]复旦大学附属儿科医院泌尿外科,上海200032

出　　处：《中华核医学杂志》2005年第5期304-305,共2页Chinese Journal of Nuclear Medicine

摘　　要：目的探讨利尿性核素肾动态显像在小儿肾积水手术疗效评价和术后随访中的临床价值。方法回顾性分析49例肾积水患儿的利尿性肾动态显像(F15法,常规方法中第15 min注射呋塞米),对肾脏影像、单肾肾小球滤过率(SKGFR)及肾图曲线进行手术前后的比较。结果①以利尿性核素肾动态显像进行积水分类,术前轻、重度积水各9例,中度积水31例,均被手术证实。功能差的25例SKGFR术前为(26.99±13.85)ml·min-1,术后为(31.15±17.04)ml·min-1,平均提高4.16 ml·min-1。②术前完全梗阻30例,部分梗阻18例,无明显梗阻1例;术后部分梗阻12例,无明显梗阻37例,没有完全梗阻病例,术后梗阻改善明显(P<0.001)。③术前肾盂输尿管交界处梗阻(UPJO)47例,输尿管膀胱交界处梗阻(UVJO)2例,术前梗阻定位为手术证实。④综合梗阻和肾脏功能信息对患儿分类,术前最差型21例,较差型28例,无正常型;术后较差型15例,正常型34例,无最差型。手术前后患儿的构成类型差异有显著性(P<0.001)。结论利尿性核素肾动态显像是评价小儿肾积水的可靠方法,能准确反映手术疗效和疾病转归并指导治疗。Objective To study the clinical value of the diuretic renal dynamic imaging （ DRDI）, in pre and post-operative pediatric hydronephrosis. Methods 49 children with hydronephrosis were retrospectively studied by the F15 DRDI （injection of furosemide at 15 min）, the static renal imaging, single kidney glomendar filtration rate（SKGFR） and the pre- and post-operative renogram. Results ①Based on DRDI, the grading of hydronephrosis was classified into mild （9 cases）, moderate （ 31 cases） and severe （9 cases）. Pre- and post-operative SKGFR in 25 cases of renal insufficiency were （26.99 ± 13.85 ） and （31. 15 ±17. O4） ml · min^-1, respectively, elevated 4. 16 ml · min^-1 in average after operation. ②Before operation there were 30 cases diagnosed complete obstruction, 18 cases partial obstruction and 1 case non-obstruction. While after operation, there was no obstruction in 37 cases, leaving 12 cases partially obstructed. The improvement of urinary tract obstruction was significant after surgery（ P 〈 O. 001 ）. ③Location of obstruction diagnosed by DRDI： 47 cases at ureteropelvic junction（UPJO） and 2 cases at ureterovesical junction（UVJO）. All were proved by operation. ④According to the comprehensive information of renal function and the obstruction grading before operation, 21 were the worst type and 28 worse type while after-operation renal function of 34 cases returned to normal and 15 cases changed to worse type. There was significant difference （P 〈 O. 001 ）. Conclusions DRDI is a reliable method to evaluate the grading of hydronephrosis in children dis- ease sequel and also as a guide for therapy. It can accurately reflect the operative effect.

关 键 词：肾积水 放射性核素显像 儿童 DTPA 核素肾动态显像 手术前后 利尿 肾盂输尿管交界处梗阻 小儿 手术疗效评价 

分 类 号：R817.4[医药卫生—影像医学与核医学]