肾盂前后径对胎儿肾积水出生后行肾盂成形术的预测价值分析  

Predictive value of anteroposterior diameter of renal pelvis in postnatal operation of fetal hydronephrosis

作　　者：彭柳成 赵夭望 李创业 彭潜龙 祖建成 涂磊 游一平 雷莹娟[2] Peng Liucheng;Zhao Yaowang;Li Chuangye;Peng Qianlong;Zu Jiancheng;Tu Lei;You Yiping;Lei Yingjuan(Department of Urology,College of Pediatrics,University of South China,Hunan Children's Hospital,Changsha 410007,China;Department of Obstetrics and Gynecology,Hunan Maternal and Child Health Hospital,Changsha 410007,China)

机构地区：[1]南华大学儿科学院,湖南省儿童医院泌尿外科,湖南省长沙市410007 [2]湖南省妇幼保健院产科,湖南省长沙市410007

出　　处：《临床小儿外科杂志》2020年第3期218-223,共6页Journal of Clinical Pediatric Surgery

基　　金：湖南省卫生与计划生育委员会科研项目(编号:B2014-125)。

摘　　要：目的分析出生前后肾盂前后径(anteroposterior diameter of renal pelvis,APD)预测胎儿肾积水患儿在随访期间行肾盂成形术的临床价值。方法回顾性分析2017年6月至2019年3月湖南省儿童医院、湖南省妇幼保健院通过产前超声检出孕中期APD≥4 mm或孕晚期APD≥7 mm胎儿肾积水患者的临床资料。在随访过程中,胎儿肾积水患者出生后结局分为手术和非手术,在手术组与非手术组间分别比较孕中期、孕晚期及出生后1个月的APD值。结果本研究共纳入98例患儿(161肾),36例患儿(40肾)因出现临床手术指征而行肾盂成形术。多因素Logistic回归分析发现,孕中期、孕晚期及出生后1个月的APD值均是肾积水患儿行肾盂成形术的危险因素。孕中期、孕晚期及出生后1个月APD值分辨肾积水患儿出生后行肾盂成形术的最佳临界值分别为7.5 mm、16.4 mm和15.5 mm,灵敏度分别为75.7%、70.3%和83.8%,特异度分别为79.0%、90.0%和87.0%。当孕中期APD值为7.5 mm、孕晚期APD值为16.4 mm或出生后1个月APD值为15.5 mm时对预测行肾盂成形术的临床价值最佳(灵敏度为91.9%,特异度为85.0%)。结论孕中期、孕晚期及出生后1个月的APD值均能在一定程度上预测患儿出生后行肾盂成形术的概率。孕晚期及出生后1个月可以更好地预测UPJO患儿出生后行肾盂成形术的最佳临界值,但在妊娠中期就可以对手术风险较高的患儿进行筛查。结合胎儿期及出生后APD值,可以提高预测UPJO患儿行肾盂成形术的准确性。Objective To explore the diagnostic value of anteroposterior diameter(APD)of renal pelvis for fetal hydronephrosis during follow-ups.Methods The clinical data were analyzed retrospectively for fetal hydronephrosis with APD greater than or equal to 4 mm in the second trimester or 7 mm in the third trimester as detected by prenatal ultrasound at Hunan Children's Hospital and Hunan Maternal&Children's Health Hospital from June 2017 to December 2018.During follow-ups,the postnatal outcome of children with fetal hydronephrosis was divided into operative and non-operative groups.Results A total of 98 children(161 kidneys)were included and 36 children(40 kidneys)underwent pyeloplasty because of operative indications.Multivariate Logistic regression analysis showed that APD values in the second trimester,the third trimester and the first postnatal month were risk factors for pyeloplasty in children with hydronephrosis.The optimal critical values of APD in the second trimester,the third trimester and the first postnatal month were 7.5,16.4 and 15.5 mm with a sensitivity of 75.7%,70.3%and 83.8%and a specificity of 79.0%,90.0%and 87.0%respectively.When APD were 7.5 mm in the second trimester,16.4 mm in the third trimester or 15.5 mm in the first postnatal month,the sensitivity and specificity of pyeloplasty were 91.9%and 85.0%respectively.Conclusion APD in the second trimester,the third trimester and the first postnatal month may predict the risk of pyeloplasty.The last two periods can better predict the optimal critical value of postnatal operation for ureteropelvic junction obstruction(UPJO)children.However,children with a high operative risk may be screened in the second trimester.A combination of fetal and postnatal APD can be employed as a screening tool of improving the accuracy of predicating pyeloplasty in UPJO children.

关 键 词：胎儿肾积水 肾盂输尿管连接部梗阻 外科手术 肾盂前后径 

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