先天性肾脏畸形202例回顾分析

Retrospective Analysis of Congenital Renal Malformation in 202 Children

目的探讨先天性肾脏畸形的检出方法及其临床特点。方法回顾性分析1987-2007年武汉市儿童医院及中山大学附属第五医院(2002-2007年)收治的202例先天性肾脏畸形的临床资料,总结其临床特点、发病率及诊断方法。结果202例先天性肾脏畸形占同期9774例肾内科住院患儿的2.07%。202例先天性肾脏畸形中,肾囊性病变64例,重复肾42例,肾发育不全34例,肾旋转不良26例,单侧无肾16例,异位肾7例,马蹄肾5例,附加肾、肾盂反常各3例,双侧无肾、盘状肾各1例。并发症中尿路感染最常见84/202例(41.58%),肾积水33/202例(16.34%),继发膀胱输尿管返流19/202例(9.41%)、慢性肾功能不全17/202例(8.42%)。并存症中先天性输尿管畸形多见42/202例(20.79%)。其中156/202例(77.23%)患儿分别以血尿、脓尿、蛋白尿、发热、腹痛和排尿异常等为首发症状就诊。100%患儿经B超检出,其中部分辅以多层螺旋CT、磁共振成像(MRI)、静脉肾盂造影(IVP)、肾-输尿管-膀胱摄影(KUB)、排泄性膀胱尿路X线造影得以确诊。结论先天性肾脏畸形中以肾囊性病变、重复肾及肾发育不全多见,当患儿出现尿路感染及原因不明的血尿、蛋白尿、排尿异常、发热、腹部包块,尤其5岁以下者应首先考虑先天性肾脏畸形存在可能。B超对诊断先天性肾脏畸形应作为首选检查,具有重要意义。

Objective To analyze the diagnostic ways in determining congenital renal malformation and its clinical features. Methods A retrospective study was carried out to review 202 children with congenital renal malformations admitted in Wuhan children＇s Hospital and the fifth affiliated hospital of Sun Yat - sen university in the last 20 years. The clinical characters,the incidence and diagnostic methods were investiagated. Results The number of children with congential renal malformation（202 cases） accounted for 2.07% of the simultaneous 9 774 hospitalized patients in the medical department of nephrology. Of 202 cases, there were 64 renal cystic diseases ,42 deplex kidneys,34 renal hypoplasia,26 renal malrntation, 17 renal agenesis ,7 ectopic kidneys ,5 horseshoe kidneys ,3 supernumerary kidneys and other diseases. Urinary tract infection was the most common in complications,which was 84 in 202 cases（41.58% ） ,and there were 33 patients with hydrocele renalis and 19 patients with secondary vesicoureteral reflux（9.41% ） ,and there were 17 patients with chronic renal insufficiency（8.42% ）. Congenital uretal malformation was common in these patients 42/202 cases（20.79% ）. One hundred and fifty - six patients（77.23% ） came to see a doctor because of finding hematuria,pyuria,preteinuria, fever,abdominal pain or paruria as the initial clinical manifestation. The patients who were finally diagnosed were all examined by ultrasound,and only small number of them were examined by multilayer spiral CT,magnetic resonance imaging （MRI） ,intravenous pyelography（IVP） ,and so on. Conclusions Renal cystic disease,deplex kidney and renal hypeplasia took up the most in congenital renal malformation 140/202 cases （69.31%）. Congenital renal malformation should be considered if patients have urinary tract infection and hematuria,proteinuria,paruria,fever,abdominal lump ,especially those under 5 years old. Ultrasound should be carried out to the make a final diagnosis of congenital renal malformation. Only a small number of patients need have. other image examinations.