148例肾盂积水胎儿出生后的随访和治疗

Postnatal treatment and follow-up for hydronephrosis in fetuses： report of 148 cases

目的分析胎儿期发现肾盂积水148例患儿的出生后随访和治疗情况，初步探讨胎儿肾盂积水出生后诊断、随访方案以及手术治疗时机的选择。方法按照美国胎儿泌尿外科协会（SFU）分级，将本院1999年1月至2006年1月收治的148例胎儿期发现肾盂积水的患儿分为4组，所有各组患儿于出生后继续B超观察随访，并辅以放射性核素扫描（ECT），磁共振水成像（MRU）等方法明确诊断，及时根据不同分级采取相应治疗方案。结果41例1级肾盂积水的患儿持续随访1年，未出现肾盂积水加重和肾功能受损迹象，未予手术干预；49例2级患儿持续随访观察3～6个月后，其中12例因肾盂持续增大，达到3级或4级诊断标准而进行手术干预，其余37例仍持续随访观察中；31例3级和27例4级患儿均在随访观察3～6个月后出现持续肾盂增大，肾功能受损，明确诊断后进行手术干预；术后恢复良好，并分别于术后1个月、3个月、6个月、1年分别行B超随访和肾功能检查，均未再出现肾盂肾盏分离加大和肾功能继续受损趋势。结论①越来越多肾盂积水在胎儿期就被早期发现并被密切随访至出生后，区别于以往偶然发现，对此病诊断、治疗、随访等也应有所转变；②胎儿期肾盂积水需要区分生理性和病理性肾盂积水，进行出生后的严密随访观察和恰当治疗；③胎儿期肾盂积水出生后需根据积水级别、动态随访结果、肾功能受损情况等选择手术时机。

Objective To present the experience in postnatal follow-up observation and treatment of the hydronephrosis in fetuses. Methods One hundred and forty eight patients from January 1999 to January 2006 were divided into 4 groups according to Society for Fetal Urology （SFU） classification. The follow-up observation and treatments were retrospectively analyzed. Results Forty-one patients in Grade-1 group had undergone follow-up for about 1 year without aggravation, who were not necessary to undergo operation. But 12 of 49 patients in Grade-2 group who had undergone follow-up for 3 to 6 months had to undergo operations because of aggravation of the hydronephrosis. Others in this group were followed up. Thirty one cases in Grade-3 group and 27 cases in Grade-4 group were op- erated on after diagnosis was identified, who recovered well. All cases were followed up by the ultrasonography at 1,3,6 and 12 months after operations. No disassociation between calices renales and pelvis renales was detected. Conclusions The operation will be needed in patients with grade 2 or higher of SFU classification. The excellent results can be gained in patients with hydronephrosis detected before birth once the rational treatment gave to them based on SFU classification.