摘要
目的 通过先天性肾盂输尿管交界处梗阻(UPJO)术后患儿的随访,了解患儿肾脏功能及形态的恢复情况,同时对随访应持续的时间,可能影响肾脏恢复的潜在因素进行探讨.方法 回顾性分析2012至2015年于我院行Anderson-Hynes术的病例42例,其中男30例,女12例,左侧35例,右侧7例,手术年龄2个月至10岁,平均手术年龄38.5个月,随访时间36~48个月,平均随访时间38个月.分析术后患儿病理学检测结果、彩超及利尿肾图结果.结果 肾实质梗阻性损伤病理分级:术前DRF<35%患儿以Ⅱ级到Ⅲ级为主,Ⅰ级较少,DRF≥35%患儿中以Ⅰ级为主,Ⅱ级到Ⅲ级较少,术后1年Ⅰ级患儿DRF提高13.03%,Ⅱ级到Ⅲ级DRF提高7.97%.肾脏形态:肾皮质厚度、肾盂前后径(APD)、肾积水最深直径、肾脏最大纵截面面积等各项指标,术后6个月变化较术前差异有统计学意义(P<0.001),但术后第12个月还未达到稳定高峰,12~24个月之间有反复波动,予保守观察,未进行进一步处理,随后各项指标稳定提升,直至第36个月达到最高峰水平.肾脏功能:术后1年除了DRF有所提升外,GFR、半排时间、达峰时间、利尿肾图曲线变化较术前差异同样具有统计学意义.结论 对于UPJO术后患儿的随访时间建议应持续3年以上.肾实质的梗阻性损伤病理分级与残留的DRF具有一定相关性,可以作为预测肾脏恢复潜能指标.对于术后患儿恢复情况,除了APD、DRF外,还可以结合彩超及利尿肾图的其他指标进行综合判断.
Objective To explore the recovery of renal function and morphology after Anderson-Hynes operation to provide rationales of duration and potential influencing factors for follow-ups.Methods A total of 42 ureteropelvic junction obstruction (UPJO) patients undergoing Anderson-Hynes between 2012 and 2015 were retrospectively evaluated.The average operative age was 38.5 months and average follow-up period was 38 months.Clinical data were analyzed by SPSS19,analysis of variance,t test and chi-square test.Results Grades of renal histopathological changes:differential renal function (DRF) ≥35% preoperatively predominantly showed minimal histopathological changes (grade Ⅰ) and DRF<35% preoperatively moderate to severe obstructive changes (grades Ⅱ & Ⅲ).Grade Ⅰ DRF improved 13.03%,grade Ⅱ-Ⅲ DRF improved 7.97% at Year 1 postoperatively.Renal morphology:renal cortex,anteroposterior diameter (APD),the deepest diameter of hydronephrosis and longitudinal section area changed statistically significant since Month 6,peaked initially at Month 12 but unsteadily,fluctuated during Months 12-24 and peaked steadily at Month 36.Renal function:At 1 year postoperatively,besides improved DRF,GFR,peak time,diuretic T1/2 and curve were statistically significant.Conclusions The postoperative follow-up duration for Anderson-Hynes should be more than 3 years.Grades of renal histopathological changes may affect recovery.Besides APD and DRF,GFR,peak time,diuretic T1/2 and curve may be analyzed comprehensively for recovery of renal function.
作者
林珊
何少华
郭国栋
许辉煌
蔡东汉
徐迪
Lin Shan;He Shaohua;Ouo Ouodong;Xu Huihuang;Cai Donghan;Xu Di(Department of Pediatric Surgery;Department of Pathology, Fujian Provincial Hospital, Fujian Provincial Clinical Medical School of Fujian Medical University ,Fuzhou 350001 ,China)
出处
《中华小儿外科杂志》
CSCD
北大核心
2018年第5期371-375,共5页
Chinese Journal of Pediatric Surgery
关键词
肾功能试验
肾盂
输尿管
随访研究
Kidney function tests
Kidney pelvis
Ureter
Follow-up studies