经皮肾穿刺造瘘置管在新生儿重度肾积水中的应用

Application of Percutaneous Nephrostomy Catheterization in Neonatal Severe Hydronephrosis

[目的]探讨经皮肾穿刺造瘘置管在治疗新生儿重度肾积水中的应用效果.[方法]本院11例重度肾积水新生儿采取超声引导下经皮肾穿刺造瘘并留置F8肾造瘘管引流.患者分别在造瘘前、术后1、3和6个月末复查彩超;在造瘘前和术后6个月实行肾核素扫描.[结果]11例患儿手术顺利,手术时间（16±4.2）min,均无肾出血、周围脏器损伤等并发症,随访6个月,未见脱管等.肾积水在穿刺后3个月内缓解,和穿刺前相比,差异具有统计学意义（P〈0.05）;肾皮质厚度在穿刺后1个月内明显增厚,和穿刺前相比,差异具有统计学意义（P〈0.05）;肾小球滤过率（GFR）在穿刺6个月后较穿刺前明显改善,其差异具有统计学意义（P〈0.05）.[结论]经皮肾穿刺造瘘置管对先天性重度肾积水新生儿安全、有效,可以充分引流尿液,改善肾功能,为择期行手术治疗原发病提供有利条件,有利于改善预后.

[Objective] To explore the efficacy of percutaneous nephrostomy catheterization for the treatment of neonatal severe hydronephrosis. [Methods] Eleven neonates with severe hydronephrosis in our hospital underwent ultrasound-guided percutaneous nephrostomy and the detaining of F8 nephrostomy tube. Color uhrasonography was performed before and 1, 3 and 6 months after the operation. Renal radioisotope scanning was performed before and 6 months after the operation. [Results] All patients operated successfully. The operation time was （16 ±4.2）min. No complications such as renal hemorrhage and the damage of adjacent organs occurred. During the follow up for 6 months, no tube detachment was found. Hydronephrosis was relieved 3 months after puncture, and there was significant different between before and after puncture（ P 〈0.05）. Renal parenchymal thickness increased a month after puncture, and there was significant difference between before and after puncture （ P 〈0.05）. Glomerular filtration rate（GFR） was improved 6 months after puncture, and there was significant difference between before and after puncture（ P 〈0.05）. [Conclusion] Percutaneous nephrostomy catheterization for the treatment of neonatal severe hydronephrosis is safe and effective, and can fully drain the urine and improve renal function so as to provide favorable condition for the scheduled operation of primary disease, and make for improving the prognosis.