不同术前分肾功能的单侧SFUⅣ度UPJO患儿术后治疗效果比较-多中心回顾性队列研究  

Comparison of prognosis of patients with unilateral SFU IV degree ureteropelvic junction obstruction of differential preoperative split renal function:a multicenter retrospective cohort study

作　　者：殷晓鸣[1] 赵谦 刘鑫[1] 杨屹[1] 王翔[2] 张斌[2] 陈方[3] 谢华[3] 陈艳[3] 宋宏程[4] 韩文文[4] Yin Xiaoming;Zhao Qian;Liu Xin;Yang Yi;Wang Xiang;Zhang Bin;Chen Fang;Xie Hua;Chen Yan;Song Hongcheng;Han Wenwen(Department of Pediatric Urology,Affiliated Shengjing Hospital,China Medical University,Shenyang 110004,China;Department of Pediatric Urology,Children s Hospital of Fudan University,Shanghai 201102,China;Department of Pediatric Urology,Children s Hospital of Shanghai,Shanghai 200040,China;Department of Pediatric Urology,Affiliated Beijing Children s Hospital,Capital Medical University,Beijing 100045,China)

机构地区：[1]中国医科大学附属盛京医院小儿泌尿外科,辽宁省沈阳市110004 [2]复旦大学附属儿科医院小儿泌尿外科,上海市201102 [3]上海市儿童医院小儿泌尿外科,上海市200040 [4]首都医科大学附属北京儿童医院小儿泌尿外科,北京市100045

出　　处：《临床小儿外科杂志》2020年第3期203-208,共6页Journal of Clinical Pediatric Surgery

基　　金：国家自然科学基金(编号:81571514)。

摘　　要：目的通过多中心回顾性队列研究,对不同术前分肾功能(split renal function,SRF)的单侧美国胎儿泌尿外科学会(Society of Fetal Urology,SFU)Ⅳ度肾盂输尿管交界处梗阻患儿术后疗效进行分析。方法以2016年1月1日至2018年12月31日于我国四个儿童临床中心接受Anderson-Hynes手术治疗的单侧SFUⅣ度肾盂输尿管交界处梗阻患儿281例(进行倾向性匹配后最终纳入214例)为研究对象,并将入选患儿分为术前SRF≥40%组与术前SRF<40%组。对患儿人口学资料,术前检查、手术方式、术后半年肾脏形态恢复、术后半年肾脏功能恢复以及术后并发症发生情况等资料进行统计学分析。结果术前SRF≥40%组与术前SRF<40%组的患儿相比,术后半年SRF更好(48.8%vs.42.1%,P<0.001),术后SRF恢复正常的比例更高(75.7%vs.35.5%,P<0.001),但术后半年SRF与术前相比恢复程度较低(1.6%vs.9.0%,P<0.001)。结论本次多中心回顾性队列研究发现,虽然术前SRF≥40%患儿术后半年SRF与术前相比恢复程度较低,但术后半年SRF更好,且术后半年SRF恢复正常患儿的比例更高,建议单侧SFUⅣ度肾盂输尿管交界处梗阻患儿SRF≥40%且出现临床症状或积水加重时应行手术治疗,而不要待SRF降至40%以下后再行手术治疗。Objective To compare the prognoses of children with unilateral SFU IV degree ureteropelvic junction obstruction(UPJO) of differential preoperative split renal function(SRF).Methods For this multicenter cohort study,retrospective reviews were conducted for 281 cases with unilateral SFU IV UPJO undergoing Anderson-Hynes pyeloplasty at four domestic institutions from January 1,2016 to December 31,2018.After propensity score-matching,214 patients were divided into groups with preoperative renal function≥40% and <40%.The clinical data of demographics,preoperative examinations,operative approaches,renal morphology recovery at 6 months post-operation,renal function recovery at 6 months post-operation and postoperative complications were analyzed statistically.Results As compared with SRF <40% group,the median SRF at 6 months of SRF≥40% group was higher(48.8% vs.42.1%,P<0.001) and the proportion of children with normal postoperative renal function was higher(75.7% vs.35.5%,P <0.001).However,the SRF recovery was lower(1.6% vs.9.0%,P <0.001).Conclusion Although children with preoperative SRF≥40% had less renal function recovery at 6 months post-operation,the proportion of those with normal postoperative renal function and postoperative SRF at 6 months post-operation were higher.Therefore children with unilateral SFU IV UPJO should be operated when SRF≥40% of them have clinical symptoms and hydronephrosis is aggravated,rather than after renal function drops below 40%.

关 键 词：肾盂成形术 肾盂输尿管交界处梗阻 外科手术 治疗结果 

分 类 号：R726.9[医药卫生—儿科] R692.7[医药卫生—临床医学]