CAJ | 학술논문

目的探讨重度肾积水新生儿期手术干预的可行性和疗效.方法回顾性分析了新生儿期接受手术治疗的18例重度肾积水患儿的临床资料.结果 16例于新生儿期行离断式肾盂输尿管成形术(Anderso-Hynes术),2例Ⅰ期行肾造瘘术,Ⅱ期行肾盂成形术,所有病例术中麻醉及手术过程顺利,术后恢复满意.术后除1例有轻度切口疝外,无术后出血、感染、吻合口瘘和吻合口狭窄等并发症.术后随访1.3年(3个月～4年),患儿生长发育正常,无尿路感染症状,患肾积水明显减轻、甚至消失,肾实质厚度增加,肾脏形态接近正常.结论新生儿期手术干预能早期解除肾内压力,不仅能尽快恢复患肾功能,而且患肾形态有望恢复正常.产前诊断重度胎儿肾积水的患儿于生后1～2周应常规行B超检查,同时结合CTU或MRU加SPECT检查以明确诊断.确诊存在器质性梗阻的新生儿,若为重度肾积水,分肾功能<35%或伴发严重泌尿系感染者,建议尽早手术干预.
목적 탐토중도신적수신생인기수술간예적가행성화료효.방법 회고성분석료신생인기접수수술치료적18례중도신적수환인적림상자료.결과 16례우신생인기행리단식신우수뇨관성형술(Anderso-Hynes술),2례Ⅰ기행신조루술,Ⅱ기행신우성형술,소유병례술중마취급수술과정순리,술후회복만의.술후제1례유경도절구산외,무술후출혈、감염、문합구루화문합구협착등병발증.술후수방1.3년(3개월～4년),환인생장발육정상,무뇨로감염증상,환신적수명현감경、심지소실,신실질후도증가,신장형태접근정상.결론 신생인기수술간예능조기해제신내압력,불부능진쾌회복환신공능,이차환신형태유망회복정상.산전진단중도태인신적수적환인우생후1～2주응상규행B초검사,동시결합CTU혹MRU가SPECT검사이명학진단.학진존재기질성경조적신생인,약위중도신적수,분신공능<35%혹반발엄중비뇨계감염자,건의진조수술간예.
Objective To present the strategy and efficacy for .severe neonatal hydronephrosis.Methods Eighteen neonates with severe hydronephrosis who underwent surgical treatments were recruited in this study.Results Sixteen patients underwent single stage Anderso-Hynes dismembered pyeloplasty.The other two patients underwent nephrostomy at the first stage, and pyeloplasty at the second stage two months later.All patients recovered from surgery without any complications except one had mild incision hernia.The patients have been followed up for an average period of 1.3 years (range, 3 montha to 4 years).No postoperative bleeding, infection, anastomotic leakage or stenosis was noted during follow-up.The hydronephrosis of the affected kidneys was significantly alleviated or even disappeared after surgery.The thickness of renal parenchyma increased, and the kidneys appcared almost normal Conclusions The function and morphology of the neonatal hydronephrotic kidneys restore quickly after relieving intrarenal pressure of the affected kidrays by surgery.The kidneys of the neonates diagnosed with severe prenatal hydronephrosis should be routinely examined by uhrasonography combining CTU , MRU or SPECT in 1-2 weeks after birth.If organic tmeteropelvic junction ohatruction is confirmed, and split function of hydronephrotic kidneys less than 35% or with severe urinary tract infection, early surgical intervention should be carried out to preserve renal functions.