CAJ | 학술논문

目的：分析先天性肾积水患儿手术前后患肾形态及功能的变化，探讨手术年龄及肾积水程度对肾脏恢复的影响，为手术时机的选择提供依据。方法对2007年至2013年82例肾积水手术患儿进行随访，收集患肾手术前后超声及肾核素显像资料，按手术年龄及术前积水程度分组：A组（1岁以内）33例；B组（1～5岁）22例；C组（5岁以上）27例。其中SFU3度28例，SFU4度54例。随访时间6～70个月，平均（20±1．5）个月。统计分析患肾功能及形态变化与手术年龄及积水程度之间的关系。结果各年龄组术后肾脏形态较术前改善，P＜0.05，肾实质面积/肾盂面积与随访时间呈正相关，r＝0.381，P＜0.05。各年龄组术后患肾分肾功能改善，C 组术后肾小球滤过率无明显变化（P＝0.053）。不同程度肾积水术后肾脏形态和功能均有好转，组间肾脏形态和肾小球滤过率改善无统计学意义，P＞0.05。SFU4度积水术后分肾功能较3度恢复明显，P＝0.02。结论 SFU3度和4度肾积水患儿手术后肾脏功能和形态均有恢复，并随着时间延长，患肾功能及形态逐渐恢复。5岁以内患儿术后患侧肾小球滤过率明显恢复。SFU 4度肾积水术后患侧分肾功能较SFU3度恢复明显。
목적：분석선천성신적수환인수술전후환신형태급공능적변화，탐토수술년령급신적수정도대신장회복적영향，위수술시궤적선택제공의거。방법대2007년지2013년82례신적수수술환인진행수방，수집환신수술전후초성급신핵소현상자료，안수술년령급술전적수정도분조：A조（1세이내）33례；B조（1～5세）22례；C조（5세이상）27례。기중SFU3도28례，SFU4도54례。수방시간6～70개월，평균（20±1．5）개월。통계분석환신공능급형태변화여수술년령급적수정도지간적관계。결과각년령조술후신장형태교술전개선，P＜0.05，신실질면적/신우면적여수방시간정정상관，r＝0.381，P＜0.05。각년령조술후환신분신공능개선，C 조술후신소구려과솔무명현변화（P＝0.053）。불동정도신적수술후신장형태화공능균유호전，조간신장형태화신소구려과솔개선무통계학의의，P＞0.05。SFU4도적수술후분신공능교3도회복명현，P＝0.02。결론 SFU3도화4도신적수환인수술후신장공능화형태균유회복，병수착시간연장，환신공능급형태축점회복。5세이내환인술후환측신소구려과솔명현회복。SFU 4도신적수술후환측분신공능교SFU3도회복명현。
Objetive To determine the effect of age at operation and SFU degree to the recovery of renal function and morphology in children with congenital hydronephrosis after pyeloplasty and to provide clinical guidance for the treatment of hydronephrosis in children. Methods 82 patients with ureteropelvic junction ob-struction who underwent pyeloplasty at our hospital between 2007 and 201 3 were retrospectively evaluated.Pre-operative and Postoperative ultrasound findings of parenchymal thickness and ratio of parenchymal area to pelvic area were recorded.glomerular filtration rate (GFR)and differential renal function (DRF)were collected from renal nuclide imaging.Patients were divided into 3 groups (groupA:33 patients with age of 0 ~1 years, groupB:22 patients with age of 2~5 years,groupC:27 patients with age older than 5 years)based on opera-tion age,and based on the Society of Fetal Urology (SFU )degree respectively,patients were divided into 2 groups (group A:28 cases with SFU 3,group B:54 cases with SFU 4 ).Mean follow-up was 20 ± 1.5 months ranged from 6 months to 70 months.Data were analyzed using SPSS,version 1 9 with t-tests and correlation analysis. Results On ultrasound parenchymal thickness and Parenchymal area/pelvic area were significantly improved in all groups,and the latter had positive correlation with the follow-up period,r=0.381 , p=0.001 .The improved GFR was seen in group A and group B significantly (group A:p=0.001 ,group B:p=0.01 4 )and no seen in the group C (p=0.053).The improved DRF was seen in all groups.The improv-ment of DRF,parenchymal thickness and parenchymal area/pelvic area have no difference between the groups based on age,but SFU degree 4 had more significant differences than degree 3 in DRF,p=0.02. Conclusion The renal function and form have been improved significantly after pyeloplasty.Patients younger than 5 years had postoperative improvement in GFR significantly.Recovery of renal function in the affected renal unit after pyeloplasty has insignificant correlation with the operation age.SFU degree is the factor of DRF.Parenchymal area/pelvic area shows higher correlation with follow-up period.