以分肾功能为参考重度肾积水肾切除指征的探讨  

Indications for nephrectomy based on differential renal function in children with severe hydronephrosis

作　　者：张碧颖 李益卫[1] 赵瑞芳[1] 阮双岁[2] Zhang BY Li YW Zhao RF Ruan SS(Department of Nuclear Medicine Department of Urology, Affiliated Children＇s Hospital, Fudan University, Shanghai 201102, China)

机构地区：[1]复旦大学附属儿科医院核医学科,上海201102 [2]复旦大学附属儿科医院泌尿外科,上海201102

出　　处：《中华小儿外科杂志》2017年第5期370-373,共4页Chinese Journal of Pediatric Surgery

摘　　要：目的是探讨能否以术前分肾功能（DRF）小于10%作为重度肾积水行肾切除术的指征。并进一步探讨若以术前分肾功能作为参考，重度肾积水行肾切除术的指征。方法回顾性分析了2008年3月至2012年8月期间，在本院泌尿外科经手术治疗的单侧UPJO肾积水患儿。根据术前分肾功能，将其分为3组，即Ⅰ组：10%≤术前DRF〈40%，Ⅱ组：5%≤术前DRF〈10%，Ⅲ组：术前DRF〈5%。分析各组手术前后分肾功能的变化，并以分肾功能增加5%作为肾功能好转的标准。采用配对样本t检验，统计学分析采用IBM SPSS v21软件，以P〈0.05作为具有统计学意义。结果共有128例患儿进入本研究，其中男108例，女20例。Ⅰ组、Ⅱ组患肾的DRF分别由术前的27.50%±7.44%、8.58%±1.38%提高到术后的39.28%±8.34%、26.73%±11.97%，两组患肾手术前后DFR的增加值均有统计学意义（P＝0.000），表明肾盂成形术后患肾分肾功能得到明显提高。而Ⅲ组患儿术后DRF由3.89%±0.88%变为3.63%±0.94%，手术前后变化值无统计学意义（P＝0.602），表明术后分肾功能没有提高。结论分肾功能小于10%不能作为小儿肾积水肾切除术的指征，这部分患儿行肾盂成形术后患肾功能有得到提高甚至恢复正常的可能。但若以术前分肾功能低于5%为参考，肾盂成形术后患肾功能未见提高，因此，可以考虑以分肾功能低于5%作为肾切除术的参考标准。ObjectiveTo confirm the indications for nephrectomy based on differential renal function （DRF） in children. MethodsRetrospective analyses were performed for 128 children undergoing pyeloplasty between March 2008 and August 2012. Both pre and postoperative scintigraphies were conducted. They were divided into groupsⅠ（n=102）, Ⅱ （n=20） and Ⅲ （n=6） according to the initial DRF： group Ⅰ, DRF between 10%-40%; group Ⅱ, DRF between 5%-10%; group Ⅲ, DRF 〈 5 %. Paired sample T test was used for analyzing the changes of DRF after pyeloplasty in 3 groups.ResultsMean postoperative function increased by 11.78% in group Ⅰand 17.84% in group Ⅱ, decreased by 0.26% in group Ⅲ. Paired sample T test showed that postoperative DRF improved in groups ⅠandⅡ while group Ⅲ showed no improvement.ConclusionsContrary to common practice, nephrectomy is not recommended for severe hydronephrotic kidney with 〈10 % of DRF on renal scintigraphy. Renal functional status improves significantly after pyeloplasty. And nephrectomy is not necessary for kidney with 〈10 % of DRF. When DRF is 〈5%, nephrectomy may be justified.

关 键 词：儿童 肾盂积水 分肾功能 肾切除术 

分 类 号：R726.9[医药卫生—儿科]