摘要
目的探讨初诊时肾功能良好的单侧肾盂输尿管连接处梗阻(UPJO)患儿保守观察的疗效。方法回顾性分析新疆维吾尔自治区人民医院2008年1月至2017年12月收治的101例单侧UPJO患儿的病例资料,男67例,女34例。初诊年龄10 d^10岁,平均年龄3.4岁。14例有腹痛症状。梗阻位于左侧52例,右侧49例。所有患儿初诊时超声检查测量肾盂前后径1.5~4.6 cm,平均(3.4±1.2)cm;肾积水美国胎儿泌尿外科学会(SFU)分级1级2例(2.0%),2级26例(25.7%),3级50例(49.5%),4级23例(22.8%)。患侧利尿性肾核素显像示分肾功能平均(45.0±3.2)%。101例中,新生儿37例(新生儿组),男21例,女16例;产前孕检超声检查发现10例,产后1个月超声检查确诊27例;梗阻位于左侧15例,右侧22例。新生儿组出生后泌尿系统扩张(UTDP)分级1级8例(23.5%),2级12例(32.4%),3级17例(45.9%)。对101例均行保守观察,指征为无肾积水相关性症状,初诊时患侧分肾功能正常,肾积水未影响患儿的呼吸、生长发育。保守观察期间根据肾积水级别每1~6个月复查1次B超,每6~12个月复查1次利尿性核素显像。随访终点为进行手术或患侧肾积水消退(连续3次泌尿系B超检查未见肾积水)。手术指征为随访期间出现肾积水相关症状、影响生长发育、分肾功能降低>10%、肾积水SFU分级或UTDP分级进行性增加。结果本组101例,随访12~60个月,中位随访时间37个月。101例中,41例(40.5%)需手术治疗,60例(59.5%)持续保守观察。SFU1级2例肾积水自发消退;SFU2级26例中,15例肾积水自发消退,7例改善,4例手术;SFU3级50例中,11例肾积水自发消退,19例好转或未改变,20例手术治疗;SFU4级23例中,6例好转(降至SFU2级),17例手术。接受手术的41例患儿中,23例利尿性核素显像提示分肾功能受损>10%,但术前分肾功能无显著降低(下降幅度>20%);20例超声检查提示肾积水升级加重,其中SFU2级升至3级3例,SFU3级升至4级17例;13例合并有积水侧腹痛、泌尿系感染等积水相关症状。新生儿组在保守观察期间利尿性核素显像均无明显下降,均未出现肾积水相关症状。37例中,26例(70.2%)持续保守观察,分别为UTDP1级8例(100.0%)、2级8例(66.7%)、3级10例(58.8%);11例接受手术,其中UTDP分级升级9例(2级升至3级4例,3级肾积水进一步进展5例),肾积水影响生长发育2例(均为UTDP3级)。所有患儿初诊时SFU分级和新生儿UTDP分级与保守观察后比较差异均有统计学意义(Ζ=1.18、Ζ=1.88,P<0.05)。结论保守观察对于单侧肾盂输尿管连接处梗阻是安全、有效的。重度肾盂积水自发消退可能性小,更应密切进行超声或影像学的随访,必要时及时手术治疗。
Objective This study was a retrospective analysis of the efficacy of conservative treatment of unilateral renal pelvic ureteral junction obstruction with good renal function at the time of initial diagnosis.Methods The clinical data of 101 children with unilateral pelvic ureteral junction obstruction from January 2008 to December 2017 was analyzed retrospectively.All the patients underwent non-surgical treatment.There were 67 males and 34 females.The age range is from 10 days to 10 years old,with an average age of 3.4 years.52 cases got left side obstruction and 49 cases got the right side obstrction.14 children had abdominal pain symptoms.Among the 37 neonates:21 male,16 female.15 were left,22 were right.10 cases were found during prenatal pregnancy,and 27 were dignosed postpartum.The indication for conservative treatment is no hydronephrosis-related symptoms or normal renal function at the initial diagnosis.The hydronephrosis did not affect the child's breathing,growth and development.The B-ultrasound was done every 1 to 6 months which depended on the different grades of hydronephrosis during a conservative observation period.The diuretic radionuclide imaging was done every 6 to 12 months.The end point of follow-up was surgery or disappear of the hydronephrosis in the affected side.Surgical indications are symptoms of hydronephrosis during follow-up which affecting growth and development,renal function reduction>10%,hydronephrosis SFU,UTDP grade progressive increase.Among them,3 cases were raised from SFU2 to SFU3,17 cases were raised from SFU3 to SFU4;4 cases of neonatal UTDP2 progressed to grade 3 hydronephrosis and UTDP3 increased in 5 cases.Regression of hydronephrosis test three consecutive urinary renal ultrasound was defined as no hydronephrosis in.Results Continuous follow-up ranged from 1 year to 5 years,a median follow-up is 37 months.Of the 101 patients,41(40.5%)required surgery,and 60(59.5%)kept conservative follow up.2 cases of SFU1 children with hydronephrosis spontaneously disappeared.Of the 26 SFU class 2 children,15(69.2%)spontaneously resolved,7(30.7%)improved,and 4 underwent surgery.Of the 50 children with SFU grade 3 hydronephrosis,11(22.0%)spontaneously resolved,19 improved or remained unchanged,and 20 patients eventually underwent surgery.Of the 23 patients with SFU grade 4 hydronephrosis,6(26.0%)improved(to SFU 2)and 17(73.9%)underwent surgery.37 of the 101 children were enrolled in the neonatal group for SFU grading while performing UTDP grading.Twenty-seven(70.2%)of the 37 neonates underwent conservative treat ment,including 8(100.0%)UTDP grade 1 hydronephrosis,8(66.7%)UTDP grade 2 hydronephrosis,and UTDP grade 310 cases(58.8%)of hydronephrosis were effective for conservative treatment.There was a statistically significant difference between the level of hydronephrosis at the time of initial diagnosis of hydronephrosis and the efficacy of conservative treatment.Conclusion Conservative treatment of unilateral ureteral pelvic and ureteral junction obstruction is safe and effective.Severe hydronephrosis is unlikely to spontaneously resolve,often accompanied by early loss of renal function,and should be followed closely by ultrasound.
作者
颜景灏
周玲
李水学
Yan Jinghao;Zhou Ling;Li Shuixue(Department of Pediatric Surgery,People′s Hospital of Xinjiang Uygur Autonomous Region,Urumqi 830000,China)
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2019年第11期806-810,共5页
Chinese Journal of Urology
