Ma Yan,Bai Dongsheng.Pathological differences between intermittent and persistent hydronephrosis in children caused by ureteropelvic junction obstruction[J].Journal of Clinical Pediatric Surgery,2026,(05):446-451.[doi:10.3760/cma.j.cn101785-202405026]
UPJO所致儿童间歇性与持续性肾积水的病理学特征差异
- Title:
- Pathological differences between intermittent and persistent hydronephrosis in children caused by ureteropelvic junction obstruction
- Keywords:
- Hydronephrosis; Pathology; Surgical Procedures; Operative; Child
- 摘要:
- 目的 探讨肾盂输尿管交界处狭窄所致间歇性与持续性肾积水患儿的病理学特征差异,为临床诊疗提供参考。方法 采用病例对照研究设计,选取2017年9月至2024年3月于首都医科大学附属首都儿童医学中心泌尿外科接受单侧离断性肾盂成形术的46例肾盂输尿管交界处狭窄患儿,根据肾积水类型分为观察组(间歇性肾积水,23例)和对照组(持续性肾积水,23例),两组患儿年龄、性别、患侧相匹配(P>0.05)。术中切除狭窄段标本,采用马松三色染色法测算胶原-肌肉比,通过Kit受体酪氨酸激酶免疫组化法统计Cajal样细胞密度(按每高倍视野细胞数量分为低密度:0~1个/高倍视野、中密度:2~3个/高倍视野、高密度:≥4个/高倍视野),同时对比两组手术前后肾盂前后径、肾皮质厚度及肾盂-皮质比值等影像学指标。结果 影像学指标方面,术前观察组肾盂前后径为(51.3±18.1)mm,显著高于对照组的(39.8±11.0)mm(P=0.012);观察组肾皮质厚度为(2.75±1.2)mm,低于对照组的(3.6±1.7)mm(P=0.057);观察组肾盂-皮质比值为(18.7±10.5),显著高于对照组的(11.1±6.1)(P=0.004)。术后观察组肾盂前后径为(7.19±3.90)mm,显著低于对照组的(11.5±1.4)mm(P＜0.001);观察组肾皮质厚度为(4.6±1.2)mm,低于对照组的(5.6±1.7)mm(P=0.043);观察组肾盂-皮质比值为(1.54±0.89),与对照组(2.03±0.78)差异无统计学意义(P=0.053)。病理学指标方面,观察组Cajal样细胞低密度视野数量为132个(57.4%)、中密度视野数量为70个(30.4%)、高密度视野数量为28个(12.2%),对照组分别为173个(75.2%)、38个(16.5%)、19个(8.3%),两组各密度视野数量对比差异均有统计学意义(P＜0.001)。观察组标本胶原含量较低、肌肉含量较高且排列更规则,胶原-肌肉比为(1.59±0.65),显著低于对照组的(3.98±1.19),差异有统计学意义(P=0.026)。结论 与持续性肾积水患儿相比,间歇性肾积水患儿肾盂输尿管交界处狭窄段存在更高的Cajal样细胞密度(中密度视野占比更高、低密度视野占比更低)及更少的胶原沉积、更高的肌肉含量(胶原-肌肉比更低),且手术前后肾盂前后径存在显著差异,提示两者病理特征具有显著区别,该发现可为肾盂输尿管交界处狭窄所致肾积水的临床诊疗及预后评估提供新依据。
- Abstract:
- Objective Toexplore the pathological differences between intermittent and persistent hydronephrosis caused by stenosis at the junction of renal pelvis and ureter in children and provide references for its clinical diagnosis and treatment.Methods A retrospective case-control study was conducted for 46 children with ureteropelvic junction obstruction (UPJO) undergoing unilateral dismembered pyeloplasty between September 2017 and March 2024.Based upon the type of hydronephrosis,they were assigned into two groups of observation (intermittent hydronephrosis,n=23) and control (persistent hydronephrosis,n=23) Age,gender and affected sideness of two groups were matched.Surgical resection of narrow segment specimens was performed and collagen muscle ratio measured with Masson’s trichrome stain.Cajal-like cell density was calculated by Kit receptor tyrosine kinase immunohistochemistry (low-density:0-1 cells/high-power field,medium density:2-3 cells/high-power field,high-density:≥4 cells/high-power field).At the same time,such imaging parameters as renal pelvis diameter,renal cortex thickness and renal pelvis cortex ratio were compared between two groups before and after surgery.Results Anterior posterior diameter of renal pelvis was significantly higher in observation group than that in control group[(51.3±18.1) vs. (39.8±11.0)mm,P=0.012]; The thickness of renal cortex was lower in observation group than that in control group[(2.75±1.2) vs. (3.6±1.7)mm,P=0.057].Renal pelvis cortex ratio was significantly higher in observation group than that in control group[(18.7±10.5) vs. (11.1±6.1),P=0.004].Anterior posterior diameter of renal pelvis was significantly lower in observation group than that in control group[(7.19±3.90) vs. (11.5±1.4)mm,P<0.001].Pelvic cortex ratio was (1.54±0.89) in observation group and (2.03±0.78) in control group.There was no significant difference (P=0.053).In terms of pathological parameters,observation group had 132 low-density fields (57.4%),70 medium density fields (30.4%) and 28 high-density fields (12.2%) of Cajal-like cells while control group had 173 fields (75.2%),38 fields (16.5%) and 19 fields (8.3%),respectively.The inter-group differences were statistically significant in the number of low-density fields (P<0.001).The collagen content of observation group specimens was lower,muscle content higher and arrangement more regular.Collagen muscle ratio was (1.59±0.65).It was significantly lower than that of control group (3.98±1.19).And the difference was statistically significant (P=0.026).Conclusion As compared with those with persistent hydronephrosis,children with intermittent hydronephrosis have higher Cajal-like cell density (higher proportion of medium density field and lower proportion of low-density field),less collagen deposition and higher muscle content (lower collagen muscle ratio) in narrow segment of renal pelvis ureteral junction.Moreover,anteroposterior diameter of renal pelvis showed a statistically significant difference before and after surgery,indicating significant differences in pathological characteristics between the two.This finding provides new evidence for clinical diagnoses,treatments and prognostic evaluations of hydronephrosis caused by stenosis of renal pelvis ureteral junction.
参考文献/References:
[1] Ficara A, Syngelaki A, Hammami A, et al.Value of routine ultrasound examination at 35-37 weeks’ gestation in diagnosis of fetal abnormalities[J].Ultrasound Obstet Gynecol, 2020, 55(1):75-80.DOI:10.1002/uog.20857.
[2] Chu H, Cao YS, Deng QF.Laparoscopic approach for intermittent hydronephrosis caused by primary ureteral fibroepithelial polyps in children[J].World J Pediatr Surg, 2021, 4(1):e000243.DOI:10.1136/wjps-2020-000243.
[3] Jayakumar TK, Pathak M.The clinical manifestations of intermittent hydronephrosis and their relationship with renal function in pediatric patients[J].J Pediatr Urol, 2021, 17(2):279-280.DOI:10.1016/j.jpurol.2021.01.025.
[4] Babu R, Vittalraj P, Sundaram S, et al.Comparison of different pathological markers in predicting pyeloplasty outcomes in children[J].J Pediatr Surg, 2020, 55(8):1616-1620.DOI:10.1016/j.jpedsurg.2019.08.015.
[5] Polok M, Borselle D, Toczewski K, et al.Detection rate of crossing vessels in pediatric hydronephrosis:transperitoneal laparoscopy versus open lumbotomy[J].Adv Clin Exp Med, 2019, 28(11):1507-1511.DOI:10.17219/acem/104528.
[6] Mitsos P, Papakonstantinou A, Kyriopoulos C, et al.Pelvic-ureteric junction obstruction due to fibroepithelial polyps-a rare case presentation and review of the literature[J].Urol Case Rep, 2025, 62:103143.DOI:10.1016/j.eucr.2025.103143.
[7] Belman AB.Ureteropelvic junction obstruction as a cause for intermittent abdominal pain in children[J].Pediatrics, 1991, 88(5):1066-1069.
[8] Williams B, Tareen B, Resnick MI.Pathophysiology and treatment of ureteropelvic junction obstruction[J].Curr Urol Rep, 2007, 8(2):111-117.DOI:10.1007/s11934-007-0059-8.
[9] Yiee JH, Johnson-Welch S, Baker LA, et al.Histologic differen-ces between extrinsic and intrinsic ureteropelvic junction obstruction[J].Urology, 2010, 76(1):181-184.DOI:10.1016/j.urology.2010.02.007.
[10] van der AA F, Roskams T, Blyweert W, et al.Identification of kit positive cells in the human urinary tract[J].J Urol, 2004, 171(6 Pt 1):2492-2496.DOI:10.1097/01.ju.0000125097.25475.17.
[11] Senol C, Onaran M, Gurocak S, et al.Changes in cajal cell density in ureteropelvic junction obstruction in children[J].J Pediatr Urol, 2016, 12(2):89.e1-89.e5.DOI:10.1016/j.jpurol.2015.08.010.
[12] Di Benedetto A, Arena S, Nicotina PA, et al.Pacemakers in the upper urinary tract[J].Neurourol Urodyn, 2013, 32(4):349-353.DOI:10.1002/nau.22310.
[13] Koleda P, Apoznanski W, Wozniak Z, et al.Changes in interstitial cell of Cajal-like cells density in congenital ureteropelvic junction obstruction[J].Int Urol Nephrol, 2012, 44(1):7-12.DOI:10.1007/s11255-011-9970-5.
[14] Samaranayake UMJE, Mathangasinghe Y, Liyanage UA, et al.Variations in the density and distribution of cajal like cells associated with the pathogenesis of ureteropelvic junction obstruction:a systematic review and meta-analysis[J].Front Surg, 2021, 8:721143.DOI:10.3389/fsurg.2021.721143.
[15] Kim WJ, Yun SJ, Lee TS, et al.Collagen-to-smooth muscle ratio helps prediction of prognosis after pyeloplasty[J].J Urol, 2000, 163(4):1271-1275.
[16] Hanna MK, Jeffs RD, Sturgess JM, et al.Ureteral structure and ultrastructure.Part II.Congenital ureteropelvic junction obstruction and primary obstructive megaureter[J].J Urol, 1976, 116(6):725-730.DOI:10.1016/s0022-5347(17)58987-9.
[17] Romao RLP, Koyle MA, Pippi Salle JL, et al.Failed pyeloplasty in children:revisiting the unknown[J].Urology, 2013, 82(5):1145-1147.DOI:10.1016/j.urology.2013.06.049.
[18] Apoznanski W, Koleda P, Wozniak Z, et al.The distribution of interstitial cells of Cajal in congenital ureteropelvic junction obstruction[J].Int Urol Nephrol, 2013, 45(3):607-612.DOI:10.1007/s11255-013-0454-7.
[19] How GY, Chang KTE, Jacobsen AS, et al.Neuronal defects an etiological factor in congenital pelviureteric junction obstruction?[J].J Pediatr Urol, 2018, 14(1):51.e1-51.e7.DOI:10.1016/j.jpurol.2017.07.014.
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备注/Memo
收稿日期:2024-5-12。
基金项目:首都儿科研究所(现首都医科大学附属首都儿童医学中心)所级课题(LCJY-2023-20)
通讯作者:白东升,Email:baids@sohu.com