Shi Meihua,Jiang Dapeng,Shao Hong.Value of “supra-normal” phenomenon on ~(99)Tc~m-ethylenedicysteine diuretic renography in children with unilateral UPJO[J].Journal of Clinical Pediatric Surgery,2021,20(04):330-333,339.[doi:10.12260/lcxewkzz.2021.04.006]
99mTc双半胱氨酸利尿肾动态显像“超正常”现象在儿童单侧UPJO诊治中的价值
- Title:
- Value of “supra-normal” phenomenon on ~(99)Tc~m-ethylenedicysteine diuretic renography in children with unilateral UPJO
- 关键词:
- 肾盂输尿管连接部梗阻; 肾/放射性核素显像; 诊断技术; 泌尿科
- 分类号:
- R726.9;R692.2;R692.7
- 摘要:
- 目的 探讨单侧肾盂输尿管连接部狭窄（ureteropelvic junction obstruction，UPJO）患者出现99mTc双半胱氨酸利尿肾动态显像"超正常"现象（患肾DRF≥55%）的临床意义，同时分析导致肾功能被高估的因素。方法 收集上海交通大学医学院附属上海儿童医学中心2014年1月至2020年5月接受肾盂成形术且临床资料完整的107例单侧UPJO患者为研究对象。根据是否存在"超正常"现象（Supra-normal DRF，SNDRF）分为SNDRF组（n=14）与非SNDRF组（n=93），总结两组病例的临床症状及影像学等检查结果。结果 在107例符合入组标准的患者中，共有14例术前肾动态显像提示存在SNDRF，两组术前APD值分别为（29.2±13.9）mm和（34.93±11.19）mm，差异有统计学意义（P=0.035）。SNDRF组术前平均DRF为56.5%。利用术前APD预测SNDRF时，其最佳阈值为26.5 mm。结论 SNDRF与积水肾肾盂增大有关。术前APD≥26.5 mm是超正常功能的可靠预测因子。对于伴或不伴SNDRF严重积水的肾脏，肾功能都有被高估的可能，应谨慎解释DRF，手术适应证不应完全依赖DRF。
- Abstract:
- Objective To explore the clinical signi? cance of "supra-normal" phenomenon for ~(99) Tc~m-ethylenedicysteine diuretic renography and predict the causative factors of renal function overestimation in children with unilateral UPJO(differential renal function DRF ≥ 55%).Methods A total of 107 children with unilateral UPJO undergoing pyeloplasty with complete clinical data from January 2014 to May 2020 were collected.They were divided into two groups of SNDRF and non-SNDRF according to with or without supra-normal function.Their clinical symptoms and imaging abnormalities were summarized.Results Among them, 14 cases showed preoperative SNDRF.The preoperative anteroposterior pelvic diameter(APD;(29.2±13.9) mm vs. (34.93±11.19) mm, P=0.035).Mean preoperative DRF was 56.5% in SNDRF group.Thus the optimal threshold point of APD for identifying supra-normal function was 26.5 mm.Conclusion Supra-normal function is correlated with expanding hydronephrosis.A preoperative APD ≥ 26.5 mm is a reliable predictor of supra-normal function.Preoperative renal function is overestimated either in SNDRF patients or severe hydronephrotic kidneys.DRF should be interpreted cautiously in kidneys with severe hydronephrosis.Surgical indication should not be dependent entirely upon DRF.
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备注/Memo
收稿日期:2020-12-09。
通讯作者:邵虹,Email:shaohong@scmc.com.cn