胎儿泌尿系统异常的宫内诊断与结局

Intrauterine diagnosis and outcome of abnormalities of fetal urinary system

目的:探讨胎儿泌尿系统异常的宫内诊断,动态观察其变化与结局,为优生优育提供理论参考及临床依据。方法:1995年1月至2003年10月开展前瞻性研究,对妊娠28周后,225例超声检查诊断为胎儿泌尿系异常者进行分类,观察结局。结果:225例中,单纯肾盂积水202例,占89.78%;多囊肾9例,占4.00%;肾盂积水伴输尿管积水8例,占3.65%;肾盂积水并输尿管积水及巨大膀胱2例,占0.89%;肾缺如4例,占1.78%。对单纯肾盂积水202例,每2～4周进行1次动态观察至分娩前,72.28%积水恢复至0级;观察至产后1周,积水恢复至0级者占92.08%;双侧输尿管积水、多囊肾、肾缺如共14例,终止妊娠13例,占92.86%,1例失访。结论:超声诊断胎儿泌尿系某些异常有较高的实用价值;不合并其他异常的单纯肾盂积水,可能与胎儿膀胱贮尿有关,是一种功能性、可逆性、良性变化;肾盂积水伴双侧输尿管积水者动态观察,积水加重者,多与泌尿系梗阻有关。双侧多囊肾及肾缺如,目前尚无特别治疗方法,一旦确诊应及早终止妊娠。

Objective：To investigate intrauterine diagnosis of some abnormalities in fetal urinary system and observe their changes and outcome dynamically so as to supply some theoretical reference and clinical basis for eugenics.Methods：From Jan.1995 to Oct.2003,225 cases of fetus with urinary abnormalities in gravidae with gestational age longer than 28 weeks were examined with ultrasonography.The abnormalities wer classified and the progress and outcom were observed dynamically.Results：Among the 225 cases withfal urinary abnormalities,202 cases were simple hydronephrosis accounting for 89.78%;9 cases were polycystic kidney accounting for 4.00%;8 cases were hydronepnrosis complicated by hydroureteosis accountiug for 3.56%;2 cases were hydronephrosis complicated by hydroureterosis and megacystis accounting for 0.89%;4 cases were agenesis of kidney accounting for 1.78%.202 cases of simple hydronephrosis wer examined dynamically per 2 to 4 weeks till parturition and 1 week after parturition,hydrondphrosis restored to grade 0 in 72.28% and 92.28% respectively.Among 14 cases with bilateral hydroureterosis or polycystic kidney or agenesis of kidney,13 cases wer perinatal death（92.86%）,1 casewas lost.Conclusion：Uitrasonography is quite useful in the diagnosis of abnormity in fetal urinary system.It was also revealed that simple fetal hydronephrosis without other abnormalities may be related to retention of bladder.It may be benign,reversible and funcitonal.Itmay be caused by obstruction,if hydronephrosis is complicated with bilateral hydroureterosis or hydronephrosis becomes more serious dynamically.There is no specific treatment for bilateral polycystic kidney and agenesis of kidney at present,and the gestation should be terminated as soon as the diagnosis established.