Wei Chun,He Dawei,Gao Jie,et al.Renal pelvis peristalsis frequency in different degrees of hydronephrosis caused by ureteropelvic junction obstruction in children[J].Journal of Clinical Pediatric Surgery,2019,18(04):288-293.[doi:10.3969/j.issn.1671-6353.2019.04.008]
儿童UPJO肾盂收缩频率与积水程度相关性的初步研究
- Title:
- Renal pelvis peristalsis frequency in different degrees of hydronephrosis caused by ureteropelvic junction obstruction in children
- 关键词:
- 肾盂输尿管连接部梗阻; 肾盂; 肾盂积水; 儿童
- 分类号:
- R726.9;R693;R692.2
- 摘要:
- 目的 探讨儿童肾盂输尿管连接部梗阻（ureteropelvic junction obstruction，UPJO）不同程度肾积水下肾盂收缩频率的变化情况。方法 收集2015年10月至2016年6月于重庆医科大学附属儿童医院经B超确诊为单侧肾积水的患儿24例，年龄7个月至13岁2个月，中位年龄4岁。术前所有患儿行积水侧输尿管导管逆行置入，21例同时行对侧输尿管导管逆行置入。通过Laborie尿动力检测仪连接输尿管导管进行上尿路动力学检测，记录肾盂2 min收缩频率和肾盂收缩时肾盂内压力变化情况，在后续进行腹腔镜下肾盂输尿管成形术时记录术中积水侧肾盂2 min收缩频率。完成尿动力检测后所有患儿进行逆行肾盂输尿管造影。对比尿动力仪和术中记录的肾盂收缩频率，同时对不同积水程度下积水侧与健侧肾盂收缩频率进行比较。结果 共12例UPJO患儿通过上尿路动力学检测同时记录到双侧肾盂收缩频率。术中记录的肾盂2 min收缩频率的中位数和四分位间距分别为7.5（IQR：4.5~10.5）次，与尿动力仪记录的肾盂2 min收缩频率的中位数和四分位间距分别为7.0（IQR：3.8~8.5）次，差异无统计学意义（Z=-1.38，P=0.167）。对于轻中度肾积水，通过尿动力仪记录到的积水侧肾盂2 min收缩频率的中位数和四分位间距分别为8.5（IQR：7.0~11.5）次，而健侧肾盂2 min收缩频率的中位数和四分位间距分别为6.0（IQR：5.0~7.5）次，差异有统计学意义（Z=-2.23，P=0.026）。对于重度积水，积水侧的肾盂2 min收缩频率的中位数和四分位间距分别为6.0（IQR：4.0~6.5）次，而健侧肾盂2 min收缩频率的中位数和四分位间距分别为10.5（IQR：8.5~11.2）次，差异有统计学意义（Z=-2.21，P=0.027）。结论 通过输尿管导管进行上尿路动力学检测可成功记录到肾盂的收缩情况。对于UPJO导致的单侧肾积水，在轻中度积水时，积水侧的肾盂收缩频率明显高于健侧。而对于重度肾积水，积水侧肾盂的收缩频率较对侧明显下降。
- Abstract:
-
Objective To evaluate renal pelvis peristalsis for different degrees of hydronephrosis. Methods Between October 2015 and June 2016,24 children with unilateral hydronephrosis as diagnosed by ultrasound were included.All children underwent retrograde ureteral catheter catheterization to hydronephrosis pelvis through cystoscopy and 21 cases underwent simultaneous catheterization to the contralateral pelvis.Both ureteral catheters were connected to the pressure sensor of Laborie and renal pelvis peristalsis frequency of 2 minutes was recorded.Then retrograde ureteropyelography was performed for confirming the position of catheter.Renal pelvis peristalsis frequency was also recorded in the following laparoscopic pyeloureteroplasty and compared with the frequency recorded by Laborie.Also renal pelvis peristalsis frequency was compared between different degrees of hydronephrosis. Results Bilateral renal pelvic peristalsis frequency of 2 minutes was successfully recorded by LABORIE in 12 patients.The 2 min pelvis peristalsis frequency (median and four minute intervals) were 7.0 (IQR:3.8-8.5) respectively and 2 min pelvis peristalsis frequency (median and four minute intervals) recorded by surgery 7.5 (IQR:4.5-10.5).No significant difference ( Z =-1.38, P =0.167) was observed.For mild- moderate degree hydronephrosis,2 min peristalsis frequency of hydronephrosis pelvis (median and four minute intervals) (8.5(IQR:7.0-11.5)) was significantly higher ( Z =-2.23, P =0.026) than that at normal side (6.0(IQR:5.0-7.5)).The 2 min pelvis peristalsis frequency for severe degree hydronephrosis (median and four minute intervals) (6.0(IQR:4.0-6.5)) was lower than normal pelvis (10.5(IQR:8.5-11.2)), Z =-2.21, P =0.027. Conclusion Renal pelvis peristalsis frequency may be recorded by a retrogradely inserted ureteral catheter.For unilateral hydronephrosis due to ureteropelvic junction obstruction,pelvis peristalsis frequency of mild-moderate hydronephrosis is higher than normal side.However,for severe hydronephrosis,peristalsis frequency of hydronephrosis pelvis is lower than normal pelvis.
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备注/Memo
收稿日期:2017-05-17。
基金项目:国家临床重点专科建设项目[国卫办医函（2013）544]；重庆市科委科技惠民计划项目（编号：cstc2016kjhmpt100—9）
通讯作者:何大维,Email:dw.he@163.com