先天性肾盂输尿管连接处梗阻所致肾积水的手术时机选择及肾小管三项指标的应用价值  

Timing of operation and application of three indexes of renal tubules in hydronephrosis caused by congenital ureteropelvic junction obstruction

作　　者：李佳[1] 刘帅 摆俊博 刘开放 娜菲莎·吐尔地 熊红星 李万富[1] 王玉杰[1] 

机构地区：[1]新疆医科大学第一附属医院小儿泌尿外科,新疆乌鲁木齐830054

出　　处：《现代泌尿外科杂志》2022年第7期539-543,共5页Journal of Modern Urology

基　　金：新疆维吾尔自治区自然科学基金面上项目(No.2022D01A141)。

摘　　要：目的探讨先天性肾盂输尿管连接处梗阻(UPJO)所致肾积水患儿的手术时机选择及肾小管三项指标的应用价值。方法回顾性分析新疆医科大学第一附属医院2018年1月-2020年12月因UPJO行单侧离断式肾盂输尿管成形术的50例患儿临床资料,按美国胎儿泌尿外科协会(SFU)分级方法50例患儿均≥3级,Grigono分级均为Ⅳ级以上。按手术实施时机分为≤1岁组(25例)、>1岁组(25例),两组患儿均早晨10时留取晨尿测定肾小管三项指标、彩色多普勒泌尿系超声以及肾动脉显像(SPECT)分析手术前后尿β2微球蛋白(β2-MG)、尿α1微球蛋白(α1-MG)、尿N乙酰βD氨基葡萄糖苷酶(NAG)水平,以及肾盂前后径(APD)、肾实质厚度、分肾功能的恢复情况;比较患儿手术前后SFU及Grigono分级的变化,术后定期随访。结果50例患儿均行Anderson-Hynes术,3例术后出现感染,给予抗炎治疗后好转,患儿的β2-MG、α1-MG、NAG水平及APD、肾实质厚度、分肾功能,术前两组比较差异均无统计学意义(P>0.05),而术后两组比较差异均有统计学意义(P<0.05),所有患者手术前后比较上述指标差异亦有统计学意义(P<0.05)。两组手术前后按SFU分级和Grigono分级标准比较:术前均无差别,而术后1岁以内实施手术组较1岁以上实施手术组SFU分级0级者[17例(68.0%)vs.9例(36.0%)],Grigono分级等级Ⅰ级者[23例(92.0%)vs.16例(64.0%)]多。平均随访时间18(4~24)个月,术后恢复较好。结论对于单侧UPJO引起的肾积水患儿应早期实施手术,可有助于术后肾功能的恢复。肾小管三项是小儿先天性肾积水术前判断肾功能损伤及术后随访肾功能恢复的重要指标。Objective To explore the timing of operation and the application of three indexes of renal tubules in children with hydronephrosis caused by congenital ureteropelvic junction obstruction(UPJO).Methods The clinical data of 50 children who underwent unilateral severe pyeloplasty due to UPJO during Jan.2018 and Dec.2020 in our hospital were retrospectively analyzed.According to the Society of Fetal Urology(SFU)grading method,all 50 children were≥grade 3,and the Grigono grade was aboveⅣ.According to the timing of operation,the patients were divided into 2 groups:operation within 1 year(n=25)and operation group after 1 year(n=25).Morning urine was collected from both groups at 10∶00 am to measure the three indexes of renal tubules.Color Doppler urinary tract ultrasound and renal artery imaging(SPECT)were used to analyze urineβ2 microglobulin(β2-MG),urine microglobulin(α1-MG),urinary N-acetyl-βD glucosaminidase(NAG),anterior and posterior renal pelvis diameter(APD),renal parenchyma thickness,and renal function.The changes of SFU and Grigono grade before and after surgery were compared,and regular follow-up was performed.Results All 50 children underwent Anderson-Hynes operation,and 3 patients developed postoperative infection,which improved after anti-inflammatory treatment.There were no significant differences inβ2-MG,α1-MG,NAG,APD,renal parenchyma thickness,and renal function between the two groups before surgery(P>0.05),but there were statistical differences after surgery(P<0.05),and there were also significant differences in the above indicators before and after surgery in all patients(P<0.05).There were no differences between the two groups in SFU grading and Grigono grading before surgery,but the group who underwent surgery within 1 year had better outcomes than the group who underwent surgery after 1 year[SFU grading of 0:17 cases(68.0%)vs.9 cases(36.0%);Grigono gradeⅠ:23 cases(92.0%)vs.16 cases(64.0%)].During the average follow-up of 18(4-24)months,all patients recovered well.Conclusion Early surg

关 键 词：肾积水 肾盂成形术 肾功能 肾小管三项 先天性肾盂输尿管连接处梗阻 儿童 

分 类 号：R692.2[医药卫生—泌尿科学]