CAJ | 학술논문

目的分析胎儿期发现肾盂积水148例患儿的出生后随访和治疗情况,初步探讨胎儿肾盂积水出生后诊断、随访方案以及手术治疗时机的选择.方法按照美国胎儿泌尿外科协会(SFU)分级,将本院1999年1月至2006年1月收治的148例胎儿期发现肾盂积水的患儿分为4组,所有各组患儿于出生后继续B超观察随访,并辅以放射性核素扫描(ECT),磁共振水成像(MRU)等方法明确诊断,及时根据不同分级采取相应治疗方案.结果 41例1级肾盂积水的患儿持续随访1年.未出现肾盂积水加重和肾功能受损迹象,未予手术干预;49例2级患儿持续随访观察3～6个月后,其中12例因肾盂持续增大,达到3级或4级诊断标准而进行手术干预,其余37例仍持续随访观察中;31例3级和27例4级患儿均在随访观察3～6个月后出现持续肾盂增大,肾功能受损,明确诊断后进行手术干预;术后恢复良好,并分别于术后1个月、3个月、6个月、1年分别行B超随访和肾功能检查,均未再出现肾盂肾盏分离加大和肾功能继续受损趋势.结论 ①越来越多肾盂积水在胎儿期就被早期发现并被密切随访至出生后,区别于以往偶然发现,对此病诊断、治疗、随访等也应有所转变;②胎儿期肾盂积水需要区分生理性和病理性肾盂积水,进行出生后的严密随访观察和恰当治疗;③胎儿期肾盂积水出生后需根据积水级别、动态随访结果、肾功能受损情况等选择手术时机.
목적 분석태인기발현신우적수148례환인적출생후수방화치료정황,초보탐토태인신우적수출생후진단、수방방안이급수술치료시궤적선택.방법 안조미국태인비뇨외과협회(SFU)분급,장본원1999년1월지2006년1월수치적148례태인기발현신우적수적환인분위4조,소유각조환인우출생후계속B초관찰수방,병보이방사성핵소소묘(ECT),자공진수성상(MRU)등방법명학진단,급시근거불동분급채취상응치료방안.결과 41례1급신우적수적환인지속수방1년.미출현신우적수가중화신공능수손적상,미여수술간예;49례2급환인지속수방관찰3～6개월후,기중12례인신우지속증대,체도3급혹4급진단표준이진행수술간예,기여37례잉지속수방관찰중;31례3급화27례4급환인균재수방관찰3～6개월후출현지속신우증대,신공능수손,명학진단후진행수술간예;술후회복량호,병분별우술후1개월、3개월、6개월、1년분별행B초수방화신공능검사,균미재출현신우신잔분리가대화신공능계속수손추세.결론 ①월래월다신우적수재태인기취피조기발현병피밀절수방지출생후,구별우이왕우연발현,대차병진단、치료、수방등야응유소전변;②태인기신우적수수요구분생이성화병이성신우적수,진행출생후적엄밀수방관찰화흡당치료;③태인기신우적수출생후수근거적수급별、동태수방결과、신공능수손정황등선택수술시궤.
Objective To present the experience in postnatal follow-up observation and treatment of the hydronephrosis in fetuses. Methods One hundred and forty eight patients from January 1999 to January 2006 were divided into 4 groups according to Society for Fetal Urology (SFU) classification. The follow-up observation and treatments were retrospectively analyzed. Results Forty-one patients in Grade-1 group had undergone follow-up for about 1 year without aggravation, who were not necessary to undergo operation. But 12 of 49 patients in Grade-2 group who had undergone follow-up for 3 to 6 months had to undergo operations because of aggravation of the hydronephrosis. Others in this group were followed up. Thirty one cases in Grade-3 group and 27 cases in Grade-4 group were operated on after diagnosis was identified, who recovered well All cases were followed up by the ultrasonography at 1, 3, 6 and 12 months after operations. No disassociation between calices renales and pelvis renales was detected. Conclusions The operation will be needed in patients with grade 2 or higher of SFU classification. The excellent results can be gained in patients with hydronephrosis detected before birth once the rational treatment gave to them based on SFU classification.