小婴儿肾积水手术治疗及预后评价

Outcomes of operation for infants with hydronephresis

目的探讨小婴儿肾积水手术指征、治疗及预后。方法总结40例小婴儿肾积水的手术治疗。全部病例术前均行彩超、IVP、静脉肾盂造影后三维CT重建及SPECT检查。所有患儿均行肾盂输尿管成形术，术后病理证实为肾盂输尿管交接处梗阻所致肾积水。术后常规随访，行彩超和SPECT检查。结果所有患儿手术经过顺利，无手术并发症。术后3个月彩超示所有患儿肾盏扩张明显减轻，肾盂前后径和肾实质厚度均较术前好转，术前肾实质平均厚度为（4．37±1．57）mm，术后为（5．89±1．66）mm；两者比较有显著差异，P=0．000。术前肾盂前后径为（4．20±1．66）cm，术后为（1．93±0．98）cm，两者比较有显著性差异，P=0．000。32例单侧肾积水术后25例肾脏功能稳定，7例有不同程度的恢复，没有恶化者。8例双侧肾积水较重侧手术，术后对侧积水均明显减轻。结论小婴儿肾积水肾盂前后径增大并出现肾盏扩张、肾实质变薄者，即使肾功能正常也以手术为佳。肾功能恶化、肾积水加重或出现临床症状者应积极手术。肾盂前后径小于2cm，肾功能在40％以上，但肾图为梗阻曲线者应密切观察。小婴儿肾积水手术效果良好，术后肾脏形态恢复显著，肾脏功能可以保存。

Objective To explore the surgical indication and prognosis of hydronephrosis in infants. Methods Forty cases with congenital hydronephrosis were admitted to our department from February 2001 to September 2007. All cases were studied by ultrasonography, IVP and enhanced three-dimensional CT and SPECT examinations. All patients underwent dismembered pyeloplasty, the ureteropelvic junction obstruction was confirmed by the histopathology study. All patients were followed up by ultrasonography and SPECT. Results All patients recovered uneventfully. The pelvic anteroposterior diameter and the thickness of the renal parenchyma were improved in all cases after operation. The average renal parenchyma thickness was improved from （4. 37 ± 1.57）mm before operation to （5. 89 ± 1.66）mm after operation. The pelvic anteroposterior diameter, on the other hand, was significantly decreased from （4. 20 ± 1.41 ）cm before operation to （1.93 ± 0. 98）cm after operation. Among unilateral hydronephrosis, the renal function was stable in 25 kidneys, improved in 7 kidneys, no deterioration. Conclusions Surgical treatment should be applied to patients with dilated calyces and thinned renal parenchyma. Patients with renal function deterioration, increased hydronephrosis or clinical symptoms also need operation. Patients with pelvic anteroposterior diameter less than 2 cm and renal function greater than 40% can undergo conservative treatment and be followed up by B ultrasound and SPECT. The prognosis of young infant hydronephrosis is good, renal function can be preserved.