先天性肾积水出生前后诊断与治疗的研究

Perinatal Diagnosis and Operative Results of Congenital Hydronephrosis in Children

目的:研究同期收治的一组出生前、一组出生后诊断的先天性肾积水患儿,手术后随访评价其产前诊断早期治疗的优越性与必要性。方法:根据症状、B 超、静脉尿路造影、核素及我院肾病研究所制定的肾功能综合评价标准,对两组共44例的术后随访进行对照研究。结果:9例出生前诊断患儿中平均手术年龄72天,随访率100%,除1例双侧巨大肾积水患几合并一侧肾下盏小结石外,余均正常。35例出生后诊断组平均手术年龄5岁,随访率65.7%;受检者核素动静态扫描全部异常;均有不同程度酸中毒;肾小管功能五项指标均呈阳性反应。结论:在同期不等数的病例对照的随访研究中,均可证实先天性肾积水的产前诊断及出生后早期手术的可行性、优越性、重要性。产前诊断值得推广。

Objective:To assess the advantages and necessityof prenatal diagnosis and early treatment for congenital hydronephrosis.Methods:Comparison was made between the postopera- tive results of 9 prenatal diagnosed congenital hydronephrosis patients and that of 35 postnatal di- agnosed cases on the postoperative symptoms,B-uhrasonography,IVU,nuclear scan and the comprehensive assess of kidney function.Results:The follow-up of 9 cases of prenatal diagnosis (average operative age.72 days)showed all getting well except one with bilateral large hy- dronephrosis still had a small stone in one of the lower calyx.The average operative age of 35 postnatal diagnosed cases was 5 years.Of them,65.7% were followed-up with abnormal nuclear scan,various degree of acidosis and positive reaction of 5 renal tubule function tests.Conclusions: The prenatal diagnosis of congenital hydronephrosis and early treatment after birth are possible and preferable.