Li Xiaoyu,Guo Yunfei,Huang Liqu.Treatments, prognoses and influencing factors of hydronephrosis with split renal function <10%[J].Journal of Clinical Pediatric Surgery,2021,20(12):1183-1188.[doi:10.12260/lcxewkzz.2021.12.016]
分肾功能低于10%肾积水的治疗决策及影响因素研究进展
- Title:
- Treatments, prognoses and influencing factors of hydronephrosis with split renal function <10%
- Keywords:
- Hydronephrosis; Ureteral Obstruction; Nephrectomy; Nephrostomy; Percutaneous; Prognosis; Root Cause Analysis
- 分类号:
- R726.92;R699.2
- 摘要:
- 先天性肾积水（congenital hydronephrosis，CHn）是儿童泌尿生殖系统常见的疾病，新生儿肾积水的发生率为1%~2%。CHn病因复杂，最常见原因是肾盂输尿管连接部梗阻（ureteropelvic junction obstruction，UPJO），占85%以上。临床上UPJO所致肾积水通常选择肾盂输尿管成形术，分肾功能（differential renal function，DRF）是目前指导手术时机较可靠的指标，但DRF<10%肾积水的治疗方案尚存争议。本文通过对DRF<10%肾积水的治疗方法及影响因素进行综述，比较不同治疗方案的优缺点及预后，探讨影响患肾功能恢复的潜在因素，旨在提高DRF<10%肾积水的治疗效果。
- Abstract:
- Congenital hydronephrosis (CHn) is a common disease of genitourinary system in children.The incidence of neonatal hydronephrosis is around 1%-2%.The etiology of CHn is rather complex.One of the most common causes is ureteropelvic junction obstruction (UPJO), accounting for over 85%.Clinically pyeloplasty is indicated for mild, moderate and severe hydronephrosis caused by UPJO while an optimal treatment of extremely severe hydronephrosis is still under debate.Pyeloplasty is ideal for hydronephrosis due to UPJO.Currently split renal function (SRF) is a more reliable indicator for guiding operative timing.However, treatment planning for hydronephrosis with SRF<10% has remained controversial.This review summarized treatment options and influencing factors of hydronephrosis with SRF<10%, compared the advantages, disadvantages and prognoses of different treatment, explored the potential factors of affecting the recovery of renal function and intended to improve the therapeutic outcomes of hydronephrosis with SRF<10%.
参考文献/References:
1 Ulman I, Jayanthi VR, Koff SA.The long-term followup of newborns with severe unilateral hydronephrosis initially treated nonoperatively[J].J Urol, 2000, 164(3 Pt 2):1101-1105.DOI:10.1097/00005392-200009020-00046.
2 Eskild-Jensen A, Munch Jorgensen 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 International, 2003, 92(7):779-782.DOI:10.1046/j.1464-410X.2003.04476.x.
3 Duckett JW.When to operate on neonatal hydronephrosis[J].Urology, 1993, 42(6):617-619.DOI:10.1016/0090-4295(93)90522-c.
4 张君颀, 耿红全.肾积水患儿的肾功能评估与结局预判[J].临床小儿外科杂志, 2020, 19(3):193-198.DOI:10.3969/j.issn.1671-6353.2020.03.001. Zhang JQ, Geng HQ.Recent advances in renal function evaluations and outcome predictions of pediatric hydronephrosis[J].J Clin Ped Sur, 2020, 19(3):193-198.DOI:10.3969/j.issn.1671-6353.2020.03.001.
5 李哲学.肾盂输尿管连接部梗阻伴肾功能损害的治疗进展[J].现代医药卫生杂志, 2016, 32(8):1200-1203.DOI:10.3969/j.issn.1009-5519.2016.08.028. Li ZX.Treatment advances of obstruction of ureteropelvic junction with renal dysfunction[J].Journal of Modern Medicine & Health, 2016, 32(8):1200-1203.DOI:10.3969/j.issn.1009-5519.2016.08.028.
6 Lone YA, Samujh R, Bhattacharya A, et al.Outcome of poorly functioning kidneys secondary to PUJO preserved by pyeloplast[J].J Pediatr Surg, 2017, 52(4):578-581.DOI:10.1016/j.jpedsurg.2016.11.039.
7 Dhillon HK.Prenatally diagnosed hydronephrosis:the Great Ormond Street experience[J].Br J Urol, 1998, 81(Suppl)239-244.DOI:10.1046/j.1464-410x.1998.0810s2039.x.
8 Thorup J, Jokela R, Cortes D, et al.The results of 15 years of consistent strategy in treating antenatally suspected pelvi-ureteric junction obstruction[J].BJU Int, 2003, 91(9):850-852.DOI:10.1046/j.1464-410x.2003.04228.x.
9 Rafique M.Nephrectomy:indications, complications and mortal ity in 154 consecutive patients[J].J Pak Med Assoc, 2007, 57(6):308-311.
10 Ransley PG, Dhillon HK, Gordon I, et al.The postnatal management of hydronephrosis diagnosed by prenatal ultrasound[J].J Urol, 1990, 144(2 Pt 2):584-587, 593-594.DOI:10.1016/s0022-5347(17)39528-9.
11 Csaicsich D, Müller T, Arbeiter K, et al.Management of congenital hydronephrosis with ureteropelvic junction obstruction:the Vienna-AKH experience 1986-2001[J].Wien Klin Wo chenschr, 2004, 116(21-22):725-729.DOI:10.1007/s00508-004-0260-4.
12 Gupta DK, Chandrasekharam VV, Srinivas M, et al.Percutaneous nephrostomy in children with ureteropelvic junction obstruction and poor renal function[J].Urology, 2001, 57(3):547-550.DOI:10.1016/s0090-4295(00)01046-3.
13 Aziz MA, Hossain AZ, Banu T, et al.In hydronephrosis less than 10% kidney function is not an indication for nephrectomy in children[J].Eur J Pediatr Surg, 2002, 12(5):304-307.DOI:10.1055/s-2002-35956.
14 Wagner M, Mayr J, Hacker FM.Improvement of renal split function in hydronephrosis with less than 10% function[J].Eur J Pediatr Surg, 2008, 18(3):156-159.DOI:10.1055/s-2008-1038445.
15 Bansal R, Ansari MS, Srivastava A, et al.Long-term results of pyeloplasty in poorly functioning kidneys in the pediatric age group[J].Journal of Pediatric Urology, 2012, 8(1):25-28.DOI:10.1016/j.jpurol.2010.12.012.
16 Zhang S, Zhang Q, Ji C, et al.Improved split renal function after percutaneous nephrostomy in young adults with severe hydronephrosis due to ureteropelvic junction obstruction[J].J Urol, 2015, 193(1):191-195.DOI:10.1016/j.juro.2014.07.005.
17 Menon P, Rao KL, Bhattacharya A, et al.Outcome analysis of pediatric pyeloplasty in units with less than 20% differential renal function[J].J Pediatr Urol, 2016, 12(3):171.e1-e7.DOI:10.1016/j.jpurol.2015.12.013.
18 Demirtas A, Guleser AS, Sonmez G, et al.Two-step treatment model for the adult patients with an obstructed kidney functioning below 10% of its capacity:a pilot study[J].Clin Exp Nephrol, 2020, 24(2):185-189.DOI:10.1007/s10157-019-01801-x.
19 Goodwin WE, Casey WC, Woolf W.Percutaneous trocar (needle) nephrostomy in hydronephrosis[J].J Am Med Assoc, 1955, 157(11):891-894.DOI:10.1001/jama.1955.02950280015005.
20 Winfield AC, Kirchner SG, Brun ME, et al.Percutaneous nephrostomy in neonates, infants, and children[J].Radiology, 1984, 151(3):617-619.DOI:10.1148/radiology.151.3.6718719.
21 Pode D, Shapiro A, Gordon R, et al.Percutaneous nephrostomy for assessment of functional recovery of obstructed kidneys[J].Urology, 1982, 19(5):482-485.DOI:10.1016/0090-4295(82)90603-3.
22 Heloury Y, Schmitt P, Allouch G, et al.Treatment of neonatal hydronephrosis by malformation of the ureteropelvic junction:interest of percutaneous nephrostomy[J].Eur Urol, 1986, 12(4):224-229.DOI:10.1159/000472623.
23 Irving HC, Arthur RJ, Thomas DF.Percutaneous nephrostomy in paediatrics[J].Clin Radiol, 1987, 38(3):245-248.DOI:10.1016/s0009-9260(87)80057-0.
24 Ismail A, Elkholy A, Zaghmout O, et al.Postnatal management of antenatally diagnosed ureteropelvic junction obstruction[J].J Pediatr Urol, 2006, 2(3):163-168.DOI:10.1016/j.jpurol.2005.07.005.
25 张栋.肾穿刺造瘘术可改善青年患者由肾盂输尿管连接部梗阻所致的重度肾积水的分肾功能[J].泌尿外科杂志(电子版), 2014, 6(3):57-58.DOI:10.3969/j.issn.1674-7410.2014.03.020. Zhang D.Renal puncture and ostomy could improve renal function of young patients with severe hydronephrosis due to an obstruction of ureteropelvic junction[J].Journal of Urology for Clinician (Electronic Version), 2014, 6(3):57-58.DOI:10.3969/j.issn.1674-7410.2014.03.020.
26 Stables DP, Ginsberg NJ, Johnson ML.Percutaneous nephrostomy:a series and review of the literature[J].AJR Am J Roentgenol, 1978, 130(1):75-82.DOI:10.2214/ajr.130.1.75.
27 Ho PC, Talner LB, Parsons CL, et al.Percutaneous nephrostomy:experience in 107 kidneys[J].Urology, 1980, 16(5):532-535.DOI:10.1016/0090-4295(80)90618-4.
28 Shellikeri S, Daulton R, Sertic M, et al.Pediatric percutaneous nephrostomy:a multicenter experience[J].J Vasc Interv Radiol, 2018, 29(3):328-334.DOI:10.1016/j.jvir.2017.09.017.
29 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.DOI:10.1097/00005392-199511000-00090.
30 Alberti C.Congenital ureteropelvic junction obstruction:physiopathology, decoupling of tout court pelvic dilatation-obstruction semantic connection, biomarkers to predict renal damage evolution[J].Eur Rev Med Pharmacol Sci, 2012, 16(2):213-219.DOI:10.1016/j.ejpb.2011.11.004.
31 Csaicsich D, Muller T, Arbeiter K, et al.Management of congenital hydronephrosis with ureteropelvic junction obstruction:the Vienna-AKH experience 1986-2001[J].Wien Klin Wochenschr, 2004, 116(21-22):725-729.DOI:10.1007/s00508-004-0260-4.
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备注/Memo
收稿日期:2020-04-28。
基金项目:江苏省自然科学基金（编号：BK20200152）
通讯作者:郭云飞,Email:guozhaooso@163.com