[1]殷晓鸣,赵谦,刘鑫,等.不同术前分肾功能的单侧SFU Ⅳ度UPJO患儿术后治疗效果比较-多中心回顾性队列研究[J].临床小儿外科杂志,2020,19(03):203-208.[doi:10.3969/j.issn.1671-6353.2020.03.003]
　Yin Xiaoming,Zhao Qian,Liu Xin,et al.Comparison of prognosis of patients with unilateral SFU Ⅳ degree ureteropelvic junction obstruction of differential preoperative split renal function:a multicenter retrospective cohort study[J].Journal of Clinical Pediatric Surgery,2020,19(03):203-208.[doi:10.3969/j.issn.1671-6353.2020.03.003]
点击复制

不同术前分肾功能的单侧SFU Ⅳ度UPJO患儿术后治疗效果比较-多中心回顾性队列研究

《临床小儿外科杂志》[ISSN:1671-6353/CN:43-1380/R] 卷: 第19卷 期数: 2020年03期 页码: 203-208 栏目: 专题·肾积水 出版日期: 2020-03-30
Title:
Comparison of prognosis of patients with unilateral SFU Ⅳ degree ureteropelvic junction obstruction of differential preoperative split renal function:a multicenter retrospective cohort study
作者:
殷晓鸣1;  赵谦1;  刘鑫1;  杨屹1;  王翔2;  张斌2;  陈方3;  谢华3;  陈艳3;  宋宏程4;  韩文文4
1. 中国医科大学附属盛京医院小儿泌尿外科(辽宁省沈阳市, 110004);
2. 复旦大学附属儿科医院小儿泌尿外科(上海市, 201102);
3. 上海市儿童医院小儿泌尿外科(上海市, 200040);
4. 首都医科大学附属北京儿童医院小儿泌尿外科(北京市, 100045)
Author(s):
Yin Xiaoming1;  Zhao Qian1;  Liu Xin1;  Yang Yi1;  Wang Xiang2;  Zhang Bin2;  Chen Fang3;  Xie Hua3;  Chen Yan3;  Song Hongcheng4;  Han Wenwen4
1. Department of Pediatric Urology, Affiliated Shengjing Hospital, China Medical University, Shenyang 110004, China;
2. Department of Pediatric Urology, Children’s Hospital of Fudan University, Shanghai 201102, China;
3. Department of Pediatric Urology, Children’s Hospital of Shanghai, Shanghai 200040, China;
4. Department of Pediatric Urology, Affiliated Beijing Children’s Hospital, Capital Medical University, Beijing 100045, China
关键词:
肾盂成形术; 肾盂输尿管交界处梗阻; 外科手术; 治疗结果
Keywords:
Pyeloplasty; Ureteropelvic Junction Obstruction; Surgical Procedures; Operative; Treatment Outcome
分类号:
R726.9;R692.7
DOI:
10.3969/j.issn.1671-6353.2020.03.003
摘要:
目的 通过多中心回顾性队列研究，对不同术前分肾功能（split renal function，SRF）的单侧美国胎儿泌尿外科学会（Society of Fetal Urology，SFU）Ⅳ度肾盂输尿管交界处梗阻患儿术后疗效进行分析。方法 以2016年1月1日至2018年12月31日于我国四个儿童临床中心接受Anderson-Hynes手术治疗的单侧SFU Ⅳ度肾盂输尿管交界处梗阻患儿281例（进行倾向性匹配后最终纳入214例）为研究对象，并将入选患儿分为术前SRF≥40%组与术前SRF<40%组。对患儿人口学资料，术前检查、手术方式、术后半年肾脏形态恢复、术后半年肾脏功能恢复以及术后并发症发生情况等资料进行统计学分析。结果 术前SRF≥40%组与术前SRF<40%组的患儿相比，术后半年SRF更好（48.8% vs. 42.1%，P<0.001），术后SRF恢复正常的比例更高（75.7% vs. 35.5%，P<0.001），但术后半年SRF与术前相比恢复程度较低（1.6% vs. 9.0%，P<0.001）。结论 本次多中心回顾性队列研究发现，虽然术前SRF≥40%患儿术后半年SRF与术前相比恢复程度较低，但术后半年SRF更好，且术后半年SRF恢复正常患儿的比例更高，建议单侧SFU Ⅳ度肾盂输尿管交界处梗阻患儿SRF≥40%且出现临床症状或积水加重时应行手术治疗，而不要待SRF降至40%以下后再行手术治疗。
Abstract:
Objective To compare the prognoses of children with unilateral SFU Ⅳ degree ureteropelvic junction obstruction (UPJO) of differential preoperative split renal function (SRF).Methods For this multicenter cohort study,retrospective reviews were conducted for 281 cases with unilateral SFU Ⅳ UPJO undergoing Anderson-Hynes pyeloplasty at four domestic institutions from January 1,2016 to December 31,2018.After propensity score-matching,214 patients were divided into groups with preoperative renal function ≥40% and <40%.The clinical data of demographics,preoperative examinations,operative approaches,renal morphology recovery at 6 months post-operation,renal function recovery at 6 months post-operation and postoperative complications were analyzed statistically.Results As compared with SRF<40% group,the median SRF at 6 months of SRF ≥40% group was higher (48.8% vs. 42.1%,P<0.001) and the proportion of children with normal postoperative renal function was higher (75.7% vs.35.5%,P<0.001).However,the SRF recovery was lower (1.6% vs. 9.0%,P<0.001).Conclusion Although children with preoperative SRF≥40% had less renal function recovery at 6 months post-operation,the proportion of those with normal postoperative renal function and postoperative SRF at 6 months post-operation were higher.Therefore children with unilateral SFU Ⅳ UPJO should be operated when SRF≥40% of them have clinical symptoms and hydronephrosis is aggravated,rather than after renal function drops below 40%.

参考文献/References:

1 Han SW,Lee SE,Kim JH,et al.Does delayed operation for pediatric ureteropelvic junction obstruction cause histopathological changes?[J].J Urol,1998,160:984-988.DOI:10.1097/00005392-199809020-00004.
2 中华医学会小儿外科分会泌尿外科学组.先天性肾盂输尿管交界处梗阻诊疗专家共识[J].中华小儿外科杂志,2018,39(11):804-810.DOI:10.3760/cma.j.issn.0253-3006.2018.11.002. Group of Urological Surgery, Branch of Pediatric Surgery, Chinese Medical Association[J].Chin J Pediatr Surg,2018,39(11):804-810.DOI:10.3760/cma.j.issn.0253-3006.2018.11.002.
3 Ulman I,Jayanthi VR,Koff SA.The long-term follow-up of newborns with severe unilateral hydronephrosis initially treated nonoperatively[J].J Urol,2000,164:1101-1105.DOI:10.1097/00005392-200009020-00046.
4 Kim SO,Yu HS,Hwang IS,et al.Early pyeloplasty for recovery of parenchymal thickness in children with unilateral ureteropelvic junction obstruction[J].Urol Int,2014,92(4):473-476.DOI:10.1159/000357144.
5 Sinha A,Bagga A,Krishna A,et al.Revised guidelines on management of antenatal hydronephrosis[J].Indian Pediatr,2013,50(2):215-231.DOI:10.1007/s13312-013-0064-6.
6 殷晓鸣,杨屹.欧洲泌尿外科学会2017年版肾盂输尿管交界处梗阻诊疗指南解读[J].临床小儿外科杂志,2018,17(7):486-488.DOI:10.3969/j.issn.1671-6353.2018.07.002. Yin XM,Yang Y.Interpretations of 2017 European Association of Urology’s Guidelines of Diagnosing & Treating Ureteropelvic Junction Obstruction[J].J Clin Ped Sur,2018,17(7):486-488.DOI:10.3969/j.issn.1671-6353.2018.07.002.
7 Prigent A,Cosgrif P,Gates GF,et al.Consensus report on quality control of quantitative measurements of renal function obtained from renogram:International Consensus Committee from the Scientific Committee of Radionuclides in Nephrourology[J].Semin Nucl Med,1999,29(2):146-159.DOI:10.1016/s0001-2998(99)80005-1.
8 Eskild-Jensen A,Gordon I,Piepsz A,et al.Interpretation of the renogram:problems and pitfalls in hydronephrosis in children[J].BJU Int,2004,94(6):887-892.DOI:10.1111/j.1464-410X.2004.05052.x.
9 Eskild-Jensen A,Munch J?rgensen T,Olsen LH,et al.Renal function may not be restored when using decreasing differential function as the criterion for surgery in unilateral hydronephrosis[J].BJU Int,2003,92(7):779-782.DOI:10.1046/j.1464-410x.2003.04476.x
10 Salem YH,Majd M,Rushton HG,et al.Outcome analysis of pediatric pyeloplasty as a function of patient age,presentation and differential renal function[J].J Urol,1995,154(5):1889-1893.
11 Harraz AM,Helmy T,Taha DE,et al.Changes in differential renal function after pyeloplasty in children[J].J Urol,2013,190(4):1468-1473.DOI:10.1016/j.juro.2013.01.004.
12 Nishi M,Matsumoto K,Fujita T,et al.Improvement in renal function and symptoms of patients treated with laparoscopic pyeloplasty for ureteropelvic junction obstruction with less than 20% split renal function[J].J Endourol,2016,30(11):1214-1218.DOI:10.1089/end.2016.0553.
13 Kumar K,Ahmad A,Kumar S,et al.Evaluation of renal histopathological changes,as a predictor of recoverability of renal function following pyeloplasty for ureteropelvic junction obstruction[J].Nephro Urol Mon,2015,7(4):e28051.DOI:10.5812/numonthly.28051.
14 Walker MR,Babikian S,Ernest AJ,et al.Sonographic evaluation of hydronephrosis in the pediatric population:is well-tempered sonography necessary?[J].J Ultrasound Med,2015,34(4):655-662.DOI:10.7863/ultra.34.4.655.
15 Helmy TE,Harraz A,Sharaf DE,et al.Can renal ultrasonography predict early success after pyeloplasty in children? A prospective study[J].Urol Int,2014,93(4):406-410.DOI:10.1159/000362504.
16 Seixas-Mikelus SA,Jenkins LC,Williot P,et al.Pediatric pyeloplasty:comparison of literature meta-analysis of laparoscopic and open techniques with open surgery at a single institution[J].J Urol,2009,182:2428-2432.DOI:10.1016/j.juro.2009.07.051.
17 Romao RLP,Koyle MA,Pippi Salle JL,et al.Failed pyeloplasty in children:revisiting the unknown[J].Urology,2013,82(5):1145-1149.DOI:10.1016/j.urology.2013.06.049.
18 Cost NG,Prieto JC,Wilcox DT.Screening ultrasound in follow-up after pediatric pyeloplasty[J].Urology,2010,76(1):175-179.DOI:10.1016/j.urology.2009.09.092.
19 Rickard M,Braga LH,Oliveria JP,et al.Percent improvement in renal pelvis antero-posterior diameter (PIAPD):Prospective validation and further exploration of cut-off values that predict success after pyeloplasty in children supporting safe monitoring with ultrasound alone[J].J Pediatr Urol,2016,12(4):228.e1-e6.DOI:10.1016/j.jpurol.2016.04.003.

相似文献/References:

[1]李怡,宋宏程,何雨竹,等.儿童先天性肾盂输尿管连接部梗阻性肾积水手术后分肾功能变化的短期随访研究[J].临床小儿外科杂志,2021,20(04):312.[doi:10.12260/lcxewkzz.2021.04.003]
　Li Yi,Song Hongcheng,He Yuzhu,et al.Short-term changes in renal function after operations for congenital ureteropelvic junction obstruction[J].Journal of Clinical Pediatric Surgery,2021,20(03):312.[doi:10.12260/lcxewkzz.2021.04.003]
[2]徐宏业,张玲玲,杜国强,等.腹腔镜肾盂成形术后双J管相关泌尿系统感染的危险因素分析[J].临床小儿外科杂志,2021,20(04):334.[doi:10.12260/lcxewkzz.2021.04.007]
　Xu Hongye,Zhang Lingling,Du Guoqiang,et al.Analysis of risk factors of double J stent-related infection after laparoscopic pyeloplasty[J].Journal of Clinical Pediatric Surgery,2021,20(03):334.[doi:10.12260/lcxewkzz.2021.04.007]
[3]周高熙,夏凡,周维,等.留置双J管意外进入对侧输尿管1例[J].临床小儿外科杂志,2022,21(07):695.[doi:10.3760/cma.j.cn101785-202103011-020]
　Zhou Gaoxi,Xia fan,Zhou Wei,et al.Accidental entry into contralateral ureter during a double J stent placement: a rare case report[J].Journal of Clinical Pediatric Surgery,2022,21(03):695.[doi:10.3760/cma.j.cn101785-202103011-020]
[4]汪添益,张宇,付明翠,等.儿童肾盂成形术后严重尿外渗的临床特点及预后分析[J].临床小儿外科杂志,2024,(04):323.[doi:10.3760/cma.j.cn101785-202403060-005]
　Wang Tianyi,Zhang Yu,Fu Mingcui,et al.Massive urinary extravasation after pyeloplasty in children:clinical features and prognoses[J].Journal of Clinical Pediatric Surgery,2024,(03):323.[doi:10.3760/cma.j.cn101785-202403060-005]
[5]李虎,潮敏,蒋加斌,等.腹腔镜肾盂成形术后非计划再手术的危险因素分析[J].临床小儿外科杂志,2024,(04):328.[doi:10.3760/cma.j.cn101785-202403060-006]
　Li Hu,Chao Min,Jiang Jiabin,et al.Analysis of risk factors of unplanned reoperation after laparoscopic pyeloplasty[J].Journal of Clinical Pediatric Surgery,2024,(03):328.[doi:10.3760/cma.j.cn101785-202403060-006]

备注/Memo

收稿日期:2020-01-05。
基金项目:国家自然科学基金（编号：81571514）
通讯作者:杨屹,Email:yangy2@sj-hospital.org

更新日期/Last Update: 1900-01-01