肾动态显像在婴儿重度肾积水治疗决策中的应用  

pplication of diuretic renal scintigraphy in the treatment of infants with severe hydronephrosis

作　　者：罗添华[1] 张旭辉[1] 赵德善[2] 朱丽茹 Luo Tianhua;Zhang Xuhui;Zhao Deshan;Zhu Liru(Department of Pediatric Surgery,Shanxi Children′s Hospital,Taiyuan 030013,China;Department of Nuclear Medicine,the Second Hospital of Shanxi Medical University,Taiyuan 030013,China)

机构地区：[1]山西省儿童医院泌尿外科,太原030013 [2]山西医科大学第二医院核医学科,太原030013

出　　处：《中华核医学与分子影像杂志》2023年第5期281-285,共5页Chinese Journal of Nuclear Medicine and Molecular Imaging

摘　　要：目的探讨婴儿重度肾积水手术与非手术组间肾动态显像参数的差异, 为临床应用核素显像决定治疗方式积累理论依据。方法回顾分析2018年3月至2021年10月间于山西省儿童医院治疗并行肾动态显像的107例重度肾积水患儿[年龄3(2, 6)个月;男90例, 女17例]资料。患儿的诊断均为肾盂输尿管交界处狭窄。将病例按治疗方案分为手术组(87例)和非手术组(20例), 用两独立样本t检验或χ^(2)检验对比2组间分肾功能(DRF)、峰值时间、半排时间、曲线类型的差异, 并将患侧DRF与肾盂前后径行Pearson相关分析。结果手术组中DRF<40%者17例, DRF 40%~55%者60例, DRF>55%(超常肾功能)者10例。DRF 40%~55%为正常, 其他为不正常。手术组患侧DRF不正常者(27例)较非手术组(3例)多, 但差异无统计学意义(χ^(2)=2.07, P=0.150)。手术组梗阻曲线占比(85.1%, 74/87)明显高于非手术组的相应占比(55.0%, 11/20;χ^(2)=7.25, P=0.007)。手术组与非手术组相比, 患肾峰值时间明显延长[(22.77±7.52)与(15.26±10.29) min;t=3.78, P<0.001], 对侧肾峰值时间亦明显延长[(11.25±8.47)与(6.65±5.75) min;t=2.30, P=0.023]。婴儿患侧DRF与其肾盂前后径呈负相关(r=-0.48, P<0.001)。结论重度肾积水婴儿DRF大部分在正常范围, 且超常肾功能常见。手术指征DRF<40%不适用于婴儿, 需结合曲线类型、彩色多普勒超声所测肾盂前后径分析。对侧肾峰值时间延长可能是婴儿重度肾积水手术评估的重要参数。Objective To explore the differences of renal dynamic imaging parameters between operation group and non-operation group in infants with severe hydronephrosis,so as to accumulate theoretical basis for diuretic renal scintigraphy to help the treatment decision making.Methods A total of 107 infants(age:3(2,6)months;90 males and 17 females)with severe hydronephrosis,who underwent diuretic renal scintigraphy between March 2018 and October 2021 in Shanxi Children′s Hospital were retrospectively reviewed.All patients were diagnosed with ureteropelvic junction obstruction and divided into operation group(n=87)and no-operation group(n=20).The differences of differential renal function(DRF),peak time,half-time and drainage curve between the two groups were compared with the independent-sample t test orχ^(2) test,and the correlation between the renal function of the affected side and the anteroposterior pelvic diameter(APD)was analyzed with Pearson correlation analysis.Results The operation group included 17 patients with DRF<40%,60 patients with DRF between 40%-55%,and 10 patients with DRF>55%(supernormal renal function).The 40%-55%was considered as normal DBF,and the rest were abnormal.Infants with abnormal renal function in the operation group(n=27)were more than those in the non-operation group(n=3),but there was no statistical difference(χ^(2)=2.07,P=0.150).The proportion of obstruction curve in the operation group(85.1%,74/87)was significantly higher than that in the non-operation group(55.0%,11/20;χ^(2)=7.24,P=0.007).Compared with the non-operation group,the peak time of affected kidney in the operation group was significantly longer((22.77±7.52)vs(15.26±10.29)min;t=3.78,P<0.001),as well as the peak time of contralateral kidney((11.25±8.47)vs(6.65±5.75)min;t=2.30,P=0.023).There was a negative correlation between the DRF of the affected side and the APD(r=-0.48,P<0.001).Conclusions The DBF is mostly in the normal range in infants with severe hydronephrosis,and supernormal renal function is common.The previou

关 键 词：肾盂积水 婴儿 放射性核素显像 99M锝五乙酸盐 

分 类 号：R726.9[医药卫生—儿科]