243例胎儿肾积水的出生后分级、手术干预和预后分析  

Analysis of postnatal grading,surgical intervention and prognosis in 243 cases fetal hydronephrosis

作　　者：高莉娟[1] 张帅 许亚坤 张静[1] 刘殿勇[1] Gao Lijuan;Zhang Shuai;Xu Yakun;Zhang Jing;Liu Dianyong(Department of Urology,Dalian Children′s Hospital,Dalian 116012,China)

机构地区：[1]大连市儿童医院泌尿外科,116012

出　　处：《中国医师进修杂志》2021年第7期632-636,共5页Chinese Journal of Postgraduates of Medicine

摘　　要：目的探讨胎儿肾积水的出生后分级、手术干预和预后情况。方法回顾性分析2014年11月至2017年11月产前诊断为胎儿肾积水并于出生后在大连市儿童医院首诊的243例患儿的临床资料。患儿出生后均行彩超检查,并根据尿路扩张(UTD)分级系统进行评估。对有手术指征患儿行手术治疗(手术组),未达到手术指征患儿进行密切随访观察(非手术组)。结果243例患儿中,男182例,女61例;首次确诊胎龄(27.5±3.2)周,孕妇年龄(29±6)岁;单侧肾积水212例,双侧肾积水31例。首次彩超检查结果显示,UTD低风险117例,中风险67例,高风险59例。患儿随访14~50个月,平均26.4个月。在随访过程中,117例UTD低风险患儿均未行手术治疗;67例UTD中风险患儿中,62例未行手术治疗,5例行手术治疗;59例UTD高风险患儿中,3例肾积水稳定未行手术治疗,56例行手术治疗。非手术组182例,手术组61例。手术组入院首次彩超UTD高风险率、肾盂前后径均明显高于非手术组[91.80%(56/61)比1.65%(3/182)、1.9(1.6,2.4)mm比0.7(0.3,1.5)mm],肾皮质厚度明显低于非手术组[3.0(1.3,4.1)mm比6.0(5.1,7.2)mm],差异有统计学意义(P<0.01或<0.05)。手术组患儿随访结果显示,术后1年肾盂前后径和肾盂前后径与肾实质厚度比值较术前明显缩小[(1.6±0.7)cm比(3.5±1.5)cm和0.3±0.2比1.1±1.0],肾皮质厚度和分肾功能较术前明显增加[(5.8±2.4)mm比(3.2±3.1)mm和(45.4±1.9)%比(39.5±2.3)%],差异有统计学意义(P<0.05)。结论胎儿肾积水出生后需行UTD肾积水分级,UTD低风险和大部分UTD中风险肾积水患儿具有相对较好的预后。UTD高风险肾积水患儿,如发现肾积水进行性加重,分肾功能下降应早期行手术治疗。Objective To investigate the postnatal grading,surgical intervention and prognosis in fetal hydronephrosis.Methods The clinical data of 243 children who were prenatally diagnosed with fetal hydronephrosis and first seen at Dalian Children′s Hospital after birth from November 2014 to November 2017 were retrospectively analyzed.All cases were followed up by routine ultrasound after birth and were assessed and graded according to the postnatal urinary tract dilation(UTD)system.The children with clinical indication for surgery underwent surgical treatment(operation group),and the children without clinical indication were closely followed up(non-operation group).Results Among 243 children,182 were male and 61 were female;the gestational age at first diagnosis was(27.5±3.2)weeks,and the maternal age was(29±6)years;212 cases were unilateral,and 31 cases were bilateral.The results of the first ultrasound examination result showed UTD low-risk was in 117 cases,medium-risk in 67 cases,high-risk in 59 cases.All the children were followed up from 14 to 50 months,with a mean of 26.4 months.During the follow-up period,117 cases with UTD low-risk did not undergo surgical treatment;62 cases of 67 with UTD medium-risk did not receive operation,and 5 were operated;while operation were performed on 56 cases of 59 with UTD high-risk,and 3 children with stable hydronephrosis were not treated surgically.The non-operation group had 182 cases,and operation group had 61 cases.The UTD high-risk rate and renal pelvis anteroposterior diameter of first ultrasound examination in operation group were significantly higher than those in non-operation group:91.80%(56/61)vs.1.65%(3/182)and 1.9(1.6,2.4)mm vs.0.7(0.3,1.5)mm,the thickness of renal parenchyma was significantly lower than that in non-operation group:3.0(1.3,4.1)mm vs.6.0(5.1,7.2)mm,and there were statistical differences(P<0.01 or<0.05).The result of follow-up in operation group showed that the renal pelvis anteroposterior diameter and the ratio of renal pelvis anteroposterior diame

关 键 词：胎儿 肾积水 预后 回顾性研究 

分 类 号：R714.5[医药卫生—妇产科学]