中华小儿外科杂志
中華小兒外科雜誌
중화소인외과잡지
CHINESE JOURNAL OF PEDIATRIC SURGERY
2014年
9期
666-670
,共5页
徐国锋%耿红全%林厚维%方晓亮%徐卯升
徐國鋒%耿紅全%林厚維%方曉亮%徐卯升
서국봉%경홍전%림후유%방효량%서묘승
尿道梗阻%肾%膀胱%放射性核素显像%尿动力学
尿道梗阻%腎%膀胱%放射性覈素顯像%尿動力學
뇨도경조%신%방광%방사성핵소현상%뇨동역학
Urethral obstruction%Kidney%Bladder%Radionuclide imaging%Urodynamics
目的 探讨后尿道瓣膜病例中pop-off现象对肾脏功能的长期保护作用.方法 回顾性分析2003年1月至2013年12月确诊为后尿道瓣膜且年龄小于3个月,并获长期随访的24例患儿的临床资料.根据患儿有、无pop-off现象分为pop-off组(7例)和无pop-off组(17例).分析病史及随访中的血肌酐值、放射性核素肾图、排泄性膀胱尿道造影(VCUG)、尿动力学结果.通过比较pop-off组和无pop-off组后尿道瓣膜患儿的血清肌酐值,来评价肾脏功能情况.膀胱功能通过临床症状和尿动力学结果进行评价.结果 pop-off组入院、出院、术后第2年的血肌酐值分别为(28.6±9.0) μmol/L、(29.4±7.7)μmol/L和(27.7±5.4》 μmol/L,无pop-off组入院、出院、术后第2年的血肌酐值分别为(62.3±44.3)μmol/L、(34.1±9.8)μmol/L和(28.2±6.5)μmol/L,两组入院时血清肌酐值比较,差异有统计学意义(P＜0.05),出院和术后第2年的血清肌酐值差异无统计学意义(P＞0.05).pop-off组病例中没有出现肾功能不全及衰竭情况;无pop-off组有1例随访中肾功能严重受损需要透析,1例死于尿毒症并发症.pop-off组无尿失禁、尿储留;无pop-off组有3例有尿储留,需要清洁导尿和夜间留置导尿,另1例尿失禁经药物和导尿治疗后膀胱功能无改善需要行膀胱扩大术.尿动力学检查结果显示,pop-off组最大逼尿肌收缩压(Pdet.max)、最大膀胱容量(MBC)分别为(86.1±20.4) ml和(78.2±18.2)ml,无pop-off组分别为(67.5±16.8)ml和(92.4±13.3)ml,两组间比较Pdet.max、MBC的差异有统计学意义(P＜0.05).结论 Pop-off机制通过牺牲一侧肾脏保护另一侧肾脏功能以及尿液外渗等自行减压方式来降低尿路的压力,保护了膀胱的功能以及肾脏的长期预后.
目的 探討後尿道瓣膜病例中pop-off現象對腎髒功能的長期保護作用.方法 迴顧性分析2003年1月至2013年12月確診為後尿道瓣膜且年齡小于3箇月,併穫長期隨訪的24例患兒的臨床資料.根據患兒有、無pop-off現象分為pop-off組(7例)和無pop-off組(17例).分析病史及隨訪中的血肌酐值、放射性覈素腎圖、排洩性膀胱尿道造影(VCUG)、尿動力學結果.通過比較pop-off組和無pop-off組後尿道瓣膜患兒的血清肌酐值,來評價腎髒功能情況.膀胱功能通過臨床癥狀和尿動力學結果進行評價.結果 pop-off組入院、齣院、術後第2年的血肌酐值分彆為(28.6±9.0) μmol/L、(29.4±7.7)μmol/L和(27.7±5.4》 μmol/L,無pop-off組入院、齣院、術後第2年的血肌酐值分彆為(62.3±44.3)μmol/L、(34.1±9.8)μmol/L和(28.2±6.5)μmol/L,兩組入院時血清肌酐值比較,差異有統計學意義(P＜0.05),齣院和術後第2年的血清肌酐值差異無統計學意義(P＞0.05).pop-off組病例中沒有齣現腎功能不全及衰竭情況;無pop-off組有1例隨訪中腎功能嚴重受損需要透析,1例死于尿毒癥併髮癥.pop-off組無尿失禁、尿儲留;無pop-off組有3例有尿儲留,需要清潔導尿和夜間留置導尿,另1例尿失禁經藥物和導尿治療後膀胱功能無改善需要行膀胱擴大術.尿動力學檢查結果顯示,pop-off組最大逼尿肌收縮壓(Pdet.max)、最大膀胱容量(MBC)分彆為(86.1±20.4) ml和(78.2±18.2)ml,無pop-off組分彆為(67.5±16.8)ml和(92.4±13.3)ml,兩組間比較Pdet.max、MBC的差異有統計學意義(P＜0.05).結論 Pop-off機製通過犧牲一側腎髒保護另一側腎髒功能以及尿液外滲等自行減壓方式來降低尿路的壓力,保護瞭膀胱的功能以及腎髒的長期預後.
목적 탐토후뇨도판막병례중pop-off현상대신장공능적장기보호작용.방법 회고성분석2003년1월지2013년12월학진위후뇨도판막차년령소우3개월,병획장기수방적24례환인적림상자료.근거환인유、무pop-off현상분위pop-off조(7례)화무pop-off조(17례).분석병사급수방중적혈기항치、방사성핵소신도、배설성방광뇨도조영(VCUG)、뇨동역학결과.통과비교pop-off조화무pop-off조후뇨도판막환인적혈청기항치,래평개신장공능정황.방광공능통과림상증상화뇨동역학결과진행평개.결과 pop-off조입원、출원、술후제2년적혈기항치분별위(28.6±9.0) μmol/L、(29.4±7.7)μmol/L화(27.7±5.4》 μmol/L,무pop-off조입원、출원、술후제2년적혈기항치분별위(62.3±44.3)μmol/L、(34.1±9.8)μmol/L화(28.2±6.5)μmol/L,량조입원시혈청기항치비교,차이유통계학의의(P＜0.05),출원화술후제2년적혈청기항치차이무통계학의의(P＞0.05).pop-off조병례중몰유출현신공능불전급쇠갈정황;무pop-off조유1례수방중신공능엄중수손수요투석,1례사우뇨독증병발증.pop-off조무뇨실금、뇨저류;무pop-off조유3례유뇨저류,수요청길도뇨화야간류치도뇨,령1례뇨실금경약물화도뇨치료후방광공능무개선수요행방광확대술.뇨동역학검사결과현시,pop-off조최대핍뇨기수축압(Pdet.max)、최대방광용량(MBC)분별위(86.1±20.4) ml화(78.2±18.2)ml,무pop-off조분별위(67.5±16.8)ml화(92.4±13.3)ml,량조간비교Pdet.max、MBC적차이유통계학의의(P＜0.05).결론 Pop-off궤제통과희생일측신장보호령일측신장공능이급뇨액외삼등자행감압방식래강저뇨로적압력,보호료방광적공능이급신장적장기예후.
Objective To explore the pop-off mechanisms protecting renal long-term function in posterior urethral valves (PUV) after value ablation.Methods A total of 24 hospitalized PUV patients aged under 3 months at our institute from 2003 to 2013 were retrospectively analyzed.The parameters of serum creatinine,effective renal plasma flow (ERPF),voiding cystourethrogram (VCUG) and urodynamics were analyzed through medical history,questionnaires and outpatient visits.Renal function was evaluated in pop-off and nopop-off groups by comparing serum creatinine at admission and discharge and Year 2 post-ablation.Bladder function was evaluated by clinical symptoms and urodynamic study.Results The inter-group difference of serum creatinine at admission was significant (28.6 ± 9.0 vs 62.3 ± 44.3,P＜0.05).However discharge serum creatinine (29.4 ± 7.7 vs 34.1 ± 9.8,P＞0.05) and serum creatinine at Year 2 post-ablation (27.7 ± 5.4 vs 28.2 ± 6.5,P＞ 0.05) were insignificant.During long-term follow-ups,1 case died of chronic renal insufficiency complication and another with chronic renal insufficiency underwent renal dialysis in nopop-off group.There were 3 cases with urinary retention undergoing clean intermittent catheterization (CIC) and overnight bladder drainage.One case received α blockers,CIC and overnight bladder drainage.But urodynamics indicated poor compliance and poor renal function.And bladder augmentation was required.The inter-group differences in Pded.max (86.1 ± 20.4 vs 67.5 ± 16.8) and MBC (78.2 ± 18.2 vs 92.4 ± 13.3) were significant (P＜0.05).Conclusions The pop-off mechanism acts as a pressure pop-off for protecting bladder and long-term renal function.
