产前检出的肾积水的临床特征和随访结果

Clinical characters and preliminary follow-up outcome of hydronephrosis detected by prenatal ultrasonography

目的探讨产前检出的肾积水的临床特征及生后处理。方法对2001年6月－2006年6月间收治的产前检出的89侧肾积水、15侧肾输尿管积水患儿进行回顾性分析。患儿生后利用超声检查和利尿性肾图进行随访。患儿出现相关症状或肾功能下降则行手术治疗。对无需手术患儿仅观察自然病程。结果89侧单纯肾积水中，42侧（47．2％）自行缓解，24侧（27．0％）需行手术，另23侧仍处于观察中。15侧肾输尿管积水中，10侧肾输尿管积水消失，4侧肾输尿管积水需接受手术，1例仍在观察中。结论胎儿期出现的肾积水存在明显的自发缓解倾向，患儿生后需进行超声检查和利尿性肾图随访，出现相关症状或肾功能下降即手术干预。

Objective To explore the clinical characters of fetal hydronephrosis and its postnatal outcome. Methods Eighty-nine cases of fetal hydronephrosis and 15 cases of hydronephrosis with dilated ureter, diagnosed between Jun. 2001 and Jun. 2006, were involved in this retrospective study. Postnatal follow-up were undertaken by ultrasonography and diuretic renography. Surgery was performed on cases with symptoms or signs or with evidence of renal function lost, and the other patients were observed only. Results Out of 89 kidneys with dilated pelvis, hydronephrosis resolved spontaneously in 42 （47. 2%） kidneys and pyeloplasty were performed in 24（27. 0%） kidneys. The other 23 kidneys are still under observation. Of 15 kidneys with dilated pelvis and ureter, hydronephrosis resolved spontaneously in 10 kidneys （75.0%） and ureteroneocystostomy were performed on 4 kidneys. Conclusions Fetal hydronephrosis has obvious trend to resolve spontaneously. Fetal hydronephrosis needs closer postnatal follow-up by ultrasonography and diuretic renography, and surgery should be performed in cases with renal compromised or cases with relative symptoms and signs.