产前检出的肾积水的临床特征与随访结果.docVIP

产前检出的肾积水的临床特征和随访结果 [摘要] 目的 探讨产前检出的肾积水的临床特征及生后处理。方法 对2001年6月－2006年6月间收治的产前检出的89侧肾积水、15侧肾输尿管积水进行回顾性分析。患儿生后利用超声检查和利尿性肾图进行随访。患儿出现相关症状或肾功能下降则行手术治疗。对无需手术患儿仅观察自然病程。 结果 89侧单纯肾积水中，42（47.2%）侧自行缓解，24（27.0%）侧需行手术，另23侧仍处于观察中。15侧肾输尿管积水中，10侧肾、输尿管积水消失，4侧肾输尿管积水需接受手术。 结论 胎儿期出现的肾积水存在明显的自发缓解倾向，患儿生后需进行超声检查和利尿性肾图随访，出现相关症状或肾功能下降即手术干预。 [关键词] 肾积水；产前；超声；利尿性肾图；手术 Clinical characterization and preliminary outcome of hydronephrosis detected by prenatal ultrasonography Geng Hong-quan, Xu Mao-sheng, Xie Hua, Xu Guo-feng, Chen Fang. Shanghai Xinhua Hospital, Shanghai Jiaotong Medical School, Shanghai, 200092, China. [Abstract] Objectives To discuss the clinical characterization of fetal hydronephrosis and its postnatal outcome. Methods we performed a retrospective study in children diagnosed as having fetal hydronephrosis between Jun, 1990 and Jun. 2001, including 89 kidneys with dilated pelvis and 15 kidneys with dilated pelvis and ureter. Postnatal follow-up were done by ultrasonography and diuretic renography. Surgery was performed in cases with symptoms or signs or with evidence of renal function lost, and the other patients were observed only. Results Of 89 kidneys with dilated pelvis, hydronephrosis resolved spontaneously in 42 (47.2%) kidneys and pyeloplasty were performed in 24(27.0%) kidneys. The other 23 kidneys are still under observation. Of 15 kidneys with dilated pelvis and ureter, hydronephrosis resolved spontaneously in 10(75.0%) kidneys and ureteroneocystostomy were performed in 4 kidneys. Conclusions Fetal hydronephrosis has obvious trend to resolve spontaneously. Fetal hydronephrosis needs closer follow-up by ultrasonography and diuretic renography postnatally, and surgery should be performed in cases with renal compromised or cases with relative symptoms and signs. [Key words] Hydronephrosis; Prenatal; Ultrasonography; Diuretic renography; Surgery 随着产前超声技术的日渐成熟和广泛应用，越来越多的先天畸形可以在产前发现。肾积水是最常见的先天畸形之一，Roth等[1]报道每100－500例产前超声中就可以发现1例肾积水。国外很多的材料显示，胎儿期出现的肾积水与年长儿的