胎儿肾积水的诊断和预后影响因素研究

The influential factor of diagnosis and prognosis of fetal hydronephrosis

目的:探讨胎儿肾积水的诊断及与预后有关的因素。方法:选择孕24至28周,29至33周,34至37周,38至40周的正常胎儿(经超声检查筛查确定)各60例,80例,94例,90例进行测量,记录肾脏长径、前后径、肾盂腔宽度及肾皮质厚度。以33周前肾盂宽度≥4mm,33周后肾盂宽度≥7mm为调查对象,填写《胎儿肾积水调查随访表》并随访其肾脏的恢复情况和治疗情况。以正常胎儿为对照组,以生后确诊为阻塞性肾脏疾病者为研究组,采用Logistic回归分析的方法调查发生肾积水的危险因素。结果:正常胎儿肾脏各径线随孕龄的增加而增大。在调查的51例患者的79个肾有胎儿肾积水,其中有11例患者的17个肾生后随访确诊为阻塞性肾脏疾病,占肾积水胎儿的21.57%;随肾盂扩张程度的增加,发生产后肾积水的比例上升。发现肾积水的孕龄早晚与预后没有关系。肾皮质厚度与预后有关。皮质厚度、妊娠合并症并发症为发生肾积水的有统计学意义的相关因素。结论:发现肾积水的胎儿后,应重视肾皮质厚度、羊水的监测,对于肾盂扩张在10mm以上者,特别是15mm以上者应重点监护。

Objectives：To investigate the criteria of ultrasonic diagnosis and prognosis factors of fetal hydronephrosis.Methods：We measured renal long and anteroposterior diameter,renal pelvis width and renocortical thickness of normal fetus.Different cases of normal fetus in different gestational ages were choosed for research.We surveyed fetus with renal pelvis width ≥4mm before 33 gestational weeks and renal pelvis width ≥7mm after 33 gestational weeks respectively,and followed up their prognosis of hydronephrosis.The normal fetus serves as control group and the infant diagnosed hydronephrosis as study group.The correlation factors were analysed with logistic regression.Result：Renal size was enlarged as increasing gestational weeks.There is relevant between thickness of paernchyma and prognosis.We investigated 79 renals of 51 fetus.There were 11 renals（21.57%） of 17 fetus were detected blockage nephrosis finally.The larger the renal pelvis width,the higher rate of hydronephrosis.There was no correlation between gestational age when the hydronephrosis was diagnosed and prognosis.Cortical thickness and gestation complication are related factors to prognosis.Conclusion：More importance should be attached to renocortical thickness and amniotic fluid monitoring of hydronephrotic fetus,especially the one whose pyelectasis ≥15mm.