目的 本研究旨在总结重度肾积水患儿新生儿期手术干预后的患肾形态和功能恢复情况,探讨重度肾积水新生儿期手术治疗的可行性和疗效。方法 回顾性分析2013年1月至2015年1月单中心连续性收治的新生儿重度肾积水的临床资料。结果 共14例新生儿重度肾积水病例纳入本次研究,均于新生儿期行Ⅰ期离断式肾盂输尿管成形术(Anderson-Hynes术)。术后12例获得超声、SPECT随访(随访率85.7%),平均随访时间19个月(6个月至2年),手术前后各项检查结果比较:彩超显示术后患肾实质[(0.7±0.12)cm]较术前[(0.38±0.04)cm]明显增厚,差异有统计学意义(t=2.522,P=0.024); 术后肾盂前后径[(2.2±0.32)cm]较术前[(4.5±0.64)cm]明显减小,差异有统计学意义(t=3.109,P=0.027); SPECT检查提示术后肾小球滤过率[(45.8±6.85)mL/min]较术前[(23.3±3.04)mL/min]明显增加,差异有统计学意义(t=2.017,P=0.048); 同时分肾功能(%)术后(51.7±0.35)较术前(34.2±0.28)也明显增加,差异有统计学意义( t=2.897,P=0.032)。结论 肾盂输尿管成形术治疗新生儿重度肾积水安全可行,能早期解除肾内压力,不仅患肾形态有望恢复正常,还能尽快恢复患肾功能。
Objective To explore the feasibility and efficacy of neonatal operation for severe hydronephrosis through assessing the recovery of kidney morphology and function. Methods This retrospective study recruited neonates with severe hydronephrosis from January 2013 to January 2015. Results Fourteen patients underwent single-stage Anderson-Hynes dismembering pyeloplasty.And 12 of them were followed up for an average period of 19(6-24)months by ultrasonic and SPECT examinations.The thickness(cm)of renal parenchyma increased postoperatively than that preoperatively [(0.7±0.12)vs.(0.3±0.04)(t=2.522,P=0.024)],anteroposterior diameter(APD)decreased postoperatively than that preoperatively [(2.2±0.32)vs.(4.5±0.64)(t=3.109,P=0.027)],glomerular filtration rate(ml/min)increased postoperatively than that preoperatively [(45.8±6.85)vs.(23.3±3.04)(t=2.017,P=0.048)] and kidney function returned almost to normal. Conclusion Hydronephrotic is both safe and feasible.And it can relieve intrarenal pressure of affected kidney by surgery early so as to recover both kidney morphology or kidney function.
