胎儿肾积水的产前诊断与预后观察

Antenatal diagnosis and prognosis of fetal hydronephrosis

目的探讨胎儿肾积水的产前超声诊断及其预后情况。方法选择2000年6月至2002年6月于我院门诊就诊和住院单胎孕妇,应用超声检查筛选并随访肾积水胎儿29例(34肾),随访时间最长为3年,同期测量15孕周至40w正常胎儿肾脏,记录肾脏集合系统内径及肾皮质厚度。结果正常胎儿的肾脏在孕34周可以测量到7mm左右集合系统的分离,肾脏皮质厚度均在5mm以上。而肾积水胎儿集合系统前后径为12mm-15mm者26肾,皮质厚度5mm以下6例,手术1例,集合系统前后径大于15mm者8肾,皮质厚度5mm以下7例,4例手术治疗。结论产前肾积水大部分都是生理性的,可随着个体的发育而自发消退,对于生后仍存在肾积水的患儿,应定期随访观察,可结合泌尿系造影检查和MRU等检查方法来协助诊断。超声检查显示肾集合系统前后径大于15mm,肾皮质厚度小于5mm的胎儿肾积水往往存在病理性梗阻,应高度重视。

Objective： To study the antenatal sonographic diagnosis and prognosis of fetal hydronephrosis. Methods： 29 fetuses （ 34 kidneys） with hydronephrosis were detected and followed up by sonography until the hydronephrosis disappeared or was treated, the longest follow - up was 3 years. The kidneys of 193 normal fetuses with gestational weeks from 15 weeks to 40 weeks were surveyed by sonography at the same time. Inner Diameter of the pelvis and thickness of parenchyma were noted and compared. Results： About 7mm of pyelic distension and thicker than 5mm of parenchyma could be found in normal fetuses. In fetuses with hydronephrosis, there were 26 kidneys with inner diameter of the pelvis dilating from 12mm to 15mm and the parenchymal thickness was less than 5mm in 6 kidneys, 1 case was operated; there were 8 kidneys with inner diameter of pelvis dilating more than 15mm and the parenchymal thickness was less than 5mm in 7 kidneys and 4 of them were operated. Conclusions： Most of the hydronephrosis in fetus is a physiological change which can disappear along with individual development. Regular follow - up should be carried out to the child with hydronephrosis after birth and some examinations such as urography and MRU may be helpful for diagnosis. It should be pay attention to the fetal hydronephrosis with pelvis dilating more than 15mm and parenchymal thickness being less than 5mm for pathological obstruction may exist.