孕期胎儿肾盂积水的临床评价  

The clinical appraisal of gestation period fetal nephrydrosis

作　　者：曹坪[1] 刘丽均[1] 张晓航[1] 常青[1] 

机构地区：[1]第三军医大学西南医院妇产科,重庆400038

出　　处：《中国医药指南（学术版）》2008年第8期5-6,共2页Guide of China Medicine

摘　　要：目的为了解孕期胎儿肾脏结构异常的变化。方法观察肾盂积水孕期及出生后的发展转归,评估其对新生儿生长发育的影响,对产前诊断肾盂分离的胎儿进行孕期连续、动态观察,产后对婴儿继续追踪、随访。结果2006年6月至2007年11月间,在本院产科系统超声检查孕妇7938例,胎儿检出单纯肾盂分离共109例,累计肾脏182只;肾盂分离合并输尿管异常扩张6例,左肾缺如1例,重复肾畸形1例,多囊肾1例。婴儿出生后随访:单纯肾盂分离胎儿出生后1月积水消退率为22.5%,3月消退率为79.1%,6月消退率为98.3%。肾盂分离合并异常扩张者3例出生后1月未提示输尿管异常扩张,肾积水减轻;另外3例胎/婴儿染色体检查均未见异常。结论单纯肾盂分离小于7mm,肾皮质厚度在5mm以上者,其积水属于生理性积水,可在孕34周后,复查超声观察分离有无进行性增加或者皮质变薄。孕34周前发现胎儿肾盂积水在7mm以上,或肾脏皮质厚度低于5mm,或合并输尿管的异常扩张者,应该高度重视,超声动态观察其变化。对于病理性肾积水出现孕周早,发展迅速者必要时胎儿镜下肾脏穿刺放水或者手术解决梗阻原因,缓解肾脏压力,尽量保证肾脏功能。产前诊断肾脏积水的所有婴儿均应随访,出生后1d、1月、3月直至积水消失。目前尚未发现胎儿肾盂积水与染色体异常相关。Objective To find out the effect of renal sinus segregation upon foetus growth and development,carry out continual and dynamic observation upon through prematal diagnosis as suffering renal sinus segregation during pregnancy,continue to followup and survey at random over foetus after parturition, and to evaluate the value of prenatal diagnosis upon foetus kidney via ultrasound. Results Ultrasonography cases of normal pregnancy diagnosis in our hospital were 7 938 cases,among which there were 109 ones diagnosed as renal sinus segregation,suggesting incidence rate was 1.3 %. Kidneys concerned were 182 cases,including 4 cases hydramnios. The renal sinus segregation of foetus occured more commonly on the left side than on the right side,and the duration was lengthened with the deterioration of the renal sinus segregation. Conclusion The temporary renal sinus segregation is considered as normal biological state. Male foetus are more prone to be attacked by the renal sinus segregation than female foetus,which is relevant with anatomic structure of male foetus＇s urinary system.

关 键 词：胎儿 肾脏 结构异常 评价 

分 类 号：R715[医药卫生—妇产科学]