儿童先天性肾盂输尿管连接部梗阻性肾积水手术后分肾功能变化的短期随访研究  

Short-term changes in renal function after operations for congenital ureteropelvic junction obstruction

作　　者：李怡 宋宏程[1] 何雨竹 张潍平[1] 孙宁[1] 田军[1] 李明磊[1] 李宁[1] 屈彦超[1] 韩文文[1] 杨洋[1] 李振武[1] 梁海燕[1] 王冠男[1] Li Yi;Song Hongcheng;He Yuzhu;Zhang Weiping;Sun Ning;Tian Jun;Li Minglei;Li Ning;Qu yanchao;Han Wenwen;Yang yang;Li Zhengwu;Liang Haiyan;Wang Guannan(Department of Urology,Beijing Children's Hospital,Capital Medical University&National Center for Children's Health,China,100045)

机构地区：[1]国家儿童医学中心,首都医科大学附属北京儿童医院泌尿外科,北京市100045

出　　处：《临床小儿外科杂志》2021年第4期312-318,共7页Journal of Clinical Pediatric Surgery

基　　金：北京市医院管理中心儿科学科协同发展中心专项经费资助(编号:XTZD20180303)。

摘　　要：目的了解单侧肾盂输尿管连接部梗阻(ureteropelvic junction obstruction,UPJO)手术后短期患侧分肾功能(differential renal function,DRF)缓解效果。方法选择2019年3月至2019年10月首都医科大学附属北京儿童医院收治的单侧UPJO行肾盂成形术患者50例为研究对象,其中男37例,女13例,手术前后均行利尿性肾动态显像检查。根据术前DRF情况分为术前DRF降低组(DRF<40%)、术前DRF正常组(40%<DRF<55%)和术前DRF超常组(DRF>55%)。分别对比各组手术前后患侧DRF及肾实质厚度(renal parenchymal thickness,PT)变化情况,进一步对比组间DRF缓解情况及术后DRF水平。结果三组患者手术年龄、方式及术后DRF差异具有统计学意义(P<0.05);在术前DRF降低组及超常组患者中,手术前后DRF差异存在统计学意义(P<0.05),术前DRF正常组患者手术前后DRF无明显变化,但肾实质厚度存在明显差异(P<0.05)。以术后DRF增加≥5%作为术后肾功能缓解标准(超常肾功能患者以术后DRF减少≥5%作为术后肾功能缓解标准),术前DRF不同组缓解率差异存在统计学意义(P<0.05),术前DRF降低组患者术后肾功能水平仍低于术前DRF正常组及术前DRF超常组患者(P<0.05)。结论术前DRF<40%的单侧UPJO患者术后短期DRF缓解显著,但其术后DRF低于术前DRF正常及超常患者。Objective To evaluate the short-term postoperative changes of differential renal function(DRF)in children with unilateral renal ureteropelvic junction obstruction(UPJO)before and after surgery.Methods From March 2019 to October 2019,a total of 50 children undergoing unilateral UPJO pyeloplasty were analyzed.There were 37 boys and 13 girls.According to the preoperative DRF,they were divided into three groups of preoperative DRF reduction(DRF<40%),preoperative DRF normal(40%<DRF<55%)and preoperative DRF supernormal(DRF>55%).Renal function and renal parenchymal thickness of the affected side in each group were compared before and after operation.There were postoperative improvements of DRF between groups.Results Significant differences existed in age,surgical approach and postoperative DRF among three groups(P<0.05).In preoperative DRF reduction and supernormal groups,there were statistical differences in DRF before and after surgery(P<0.05).It showed no significant change in DRF before and after operation in preoperative DRF normal group.In preoperative DRF normal group,significant differences existed in renal parenchymal thickness(P<0.05).An elevation of postoperative DRF ≥5% was adopted as a standard of postoperative improvement of renal function(postoperative reduction of DRF ≥5% as a standard for preoperative DRF supernormal group),postoperative improvement of DRF showed significant statistical differences among three groups(P<0.05).However,the level of postoperative renal function was still lower in preoperative DRF reduction group than that in preoperative DRF normal and supernormal groups(all P<0.05).Conclusion Renal function in preoperative DRF<40%group recovered markedly.However,the level of postoperative renal function was still lower in preoperative DRF reduction group than that in preoperative DRF non-reduction group.

关 键 词：肾盂输尿管连接部梗阻 肾积水/诊断 肾盂成形术 肾功能试验 

分 类 号：R726.9[医药卫生—儿科] R692.2[医药卫生—临床医学]