超声诊断评价胎儿单纯肾积水产后转归临床价值  

Value of prenatal ultrasonography in evaluation of postpartum prognosis of fetal simple hydronephrosis

作　　者：郭立华[1] 张谦[1] 孙权[1] 范应中[1] 陈涛[1] 闫跃强 李岩[1] 

机构地区：[1]郑州大学第一附属医院小儿外科,河南郑州450052

出　　处：《中国实用儿科杂志》2016年第11期830-833,共4页Chinese Journal of Practical Pediatrics

摘　　要：目的探讨超声评价胎儿无输尿管扩张的单纯肾积水预后的价值,寻找最佳超声评价指标,预测胎儿单纯肾积水产后的转归。方法回顾郑州大学第一附属医院小儿外科2012年8月至2014年12月期间的产前彩超数据,将产前疑诊为肾盂输尿管连接处梗阻(UPJO)致肾积水,出生后明确诊断行肾盂成形术(n=49)的患儿(手术组)与保守治疗的(n=40)肾积水患儿(保守组)的晚期妊娠彩超数据进行对比。结果手术组与保守组的肾盂前后径及肾实质厚度平均值差异均有统计学意义,分别是(23.8±8.8)mm、(15.0±5.1)mm(P<0.0001);(5.2±2.9)mm、(8.4±2.3)mm(P=0.007)。手术组的肾盂前后径与肾实质厚度的平均比值较保守组明显增高,两组分别是(5.8±4.0)、(2.2±1.1)(P<0.0001)。结论产前胎儿单纯肾盂积水,肾盂前后径>15 mm可能是需外科手术干预的一个预测指标。肾盂前后径与肾实质厚度的比值>2.2提示有病理意义的肾盂分离及UPJO存在的可能性,预测出生后外科手术可能性增大,提示对患儿出生前后的肾积水情况需要更加密切监测,必要时尽早手术干预。Objective To explore the clinical value of ultrasonography in evaluation of prognosis of fetal simple hydronephrosis not complicated with ureterectasia in order to find out the best ultrasonic evaluation index, which can predict the outcome of simple hydronephrosis. Methods Retrospective data on prenatal sonographic parameters were compared between patients who had been clinically suspected prenatally with UPJO of hydronephrosis and later underwent postnatal pyeloplasty for ureteropelvic junction obstruction（n=49） and patients who were treated conservatively（n=40）. Results Significant differences were found between the surgically and conservatively treated patients for meananterior-posterior renal diameter[（23.8±8.8） mm vs. （15.0±5.1） mm]（P〈0.0001） and parenchymal thickness[（5.2±2.9）mm vs. （8.4±2.3） mm]（P=0.007）. Mean ratio of anterior-posterior diameter to parenchymal thickness was significantly higher in the postnatal pyeloplasty group[（5.8±4.0） vs. （2.2±1.1）]（P〈0.0001）. Conclusion For prenatal simple hydronephrosis,anterior-posterior diameter 〉15 mm is the best single predictor of the need for surgery. A ratio of 〉2.2 of renal pelvis anterior-posterior diameter to parenchymal thickness suggests UPJO and predicts the probability of the need for surgery and supports the use of more intensive prenatal and postnatal surveillance.

关 键 词：超声 胎儿 肾积水 肾盂前后径 肾实质厚度 

分 类 号：R72[医药卫生—儿科]