65例胎儿肾积水的超声诊断与预后观察

The Value of Ultrasonography in the Diagnosis and Prognostic Assessment of 65 Cases with Fetal Hydronephrosis

目的:探讨胎儿肾积水的超声诊断和预后情况。方法:对65例孕龄33～40周的胎儿81个肾积水按肾盂前后径值(APD)法进行分级(Ⅰ级～Ⅳ级),出生后1月、3月、6月超声检查随访肾积水的情况,对疾病进展的患儿随访至10个月,经手术治疗的患儿术后1个月后随访1次。结果:81个肾积水中72个肾积水为生理性(88.9%)。Ⅰ级41个肾均于出生后6个月内好转,其中1个月内好转30个肾;Ⅱ级27个肾均于6个月内好转,其中3个月内好转16个肾;Ⅲ级6个肾中有2个进展;Ⅳ级7个肾中5个行手术治疗,手术治疗的肾积水占6.2%(5/81)。有进展需继续观察的Ⅲ级和Ⅳ级肾积水各2个,占4.9%(4/81),其他影像学检查均为较轻肾盂输尿管连接部狭窄,暂无手术指征。结论:胎儿肾积水大多数是生理性,仅少部分为泌尿系畸形需手术治疗,且多为Ⅳ级肾积水。超声检查是诊断胎儿肾积水和判断预后最佳手段。

Objective：To investigate the value of ultrasonogrphy in the diagnosis and prognostic evaluation of fetal hydronephrosis.Methods：81 kidneys of fetal hydronephrosis in 65 pregnant women at 33 to 40 gestational weeks were enrolled into this study. All cases were classified into four grades according to renal anterior-posterior diameter （APD） and were followed up in the 1st month, 3rd months and 6th months after birth by ultrasonography. Specially, the follow-up of advanced cases lasted for 10 months. The infant was followed up once one month after operation.Results：Among 81 hydronephrosis, 72 were physiological （88.9%）. 41 kidneys of grade I were improved within 6 months after birth, 30 kidneys were improved within one month. All 27 kidneys of grade II were improved within 6 months, 16 kidneys were improved within three month. 2 kidneys in 6 of grade III were progressed. 5 kidneys in 7 of grade IV underwent operation, the surgical treatment rate of hydronephrosis was 6.2% （5/81）. 2 hydronephrosis with grade III and IV were advanced and needed to be observed occupying 4.9%（4/81）. The other imaging test showed gently ureteropelvic junction obstruction without operation indication.Conclusions：Most of fetal hydronephrosis are physiological, only a small part of them need surgical treatment due to urinary malformations and mostly are grade IV. Ultrasonography is the best way to diagnose and evaluate the prognosis of fetal hydronephrosis.