肾积水患儿术后肾形态及功能恢复的比较研究

Comparative study for the recovery of renal function and form after pyeloplasty

目的：分析先天性肾积水患儿手术前后患肾形态及功能的变化，探讨手术年龄及肾积水程度对肾脏恢复的影响，为手术时机的选择提供依据。方法对2007年至2013年82例肾积水手术患儿进行随访，收集患肾手术前后超声及肾核素显像资料，按手术年龄及术前积水程度分组：A组（1岁以内）33例；B组（1～5岁）22例；C组（5岁以上）27例。其中SFU3度28例，SFU4度54例。随访时间6～70个月，平均（20±1．5）个月。统计分析患肾功能及形态变化与手术年龄及积水程度之间的关系。结果各年龄组术后肾脏形态较术前改善，P＜0.05，肾实质面积/肾盂面积与随访时间呈正相关，r＝0.381，P＜0.05。各年龄组术后患肾分肾功能改善，C 组术后肾小球滤过率无明显变化（P＝0.053）。不同程度肾积水术后肾脏形态和功能均有好转，组间肾脏形态和肾小球滤过率改善无统计学意义，P＞0.05。SFU4度积水术后分肾功能较3度恢复明显，P＝0.02。结论 SFU3度和4度肾积水患儿手术后肾脏功能和形态均有恢复，并随着时间延长，患肾功能及形态逐渐恢复。5岁以内患儿术后患侧肾小球滤过率明显恢复。SFU 4度肾积水术后患侧分肾功能较SFU3度恢复明显。

Objetive To determine the effect of age at operation and SFU degree to the recovery of renal function and morphology in children with congenital hydronephrosis after pyeloplasty and to provide clinical guidance for the treatment of hydronephrosis in children. Methods 82 patients with ureteropelvic junction ob-struction who underwent pyeloplasty at our hospital between 2007 and 201 3 were retrospectively evaluated.Pre-operative and Postoperative ultrasound findings of parenchymal thickness and ratio of parenchymal area to pelvic area were recorded.glomerular filtration rate （GFR）and differential renal function （DRF）were collected from renal nuclide imaging.Patients were divided into 3 groups （groupA：33 patients with age of 0 -1 years, groupB：22 patients with age of 2-5 years,groupC：27 patients with age older than 5 years）based on opera-tion age,and based on the Society of Fetal Urology （SFU ）degree respectively,patients were divided into 2 groups （group A：28 cases with SFU 3,group B：54 cases with SFU 4 ）.Mean follow-up was 20 ± 1.5 months ranged from 6 months to 70 months.Data were analyzed using SPSS,version 1 9 with t-tests and correlation analysis. Results On ultrasound parenchymal thickness and Parenchymal area/pelvic area were significantly improved in all groups,and the latter had positive correlation with the follow-up period,r=0.381 , p=0.001 .The improved GFR was seen in group A and group B significantly （group A：p=0.001 ,group B：p=0.01 4 ）and no seen in the group C （p=0.053）.The improved DRF was seen in all groups.The improv-ment of DRF,parenchymal thickness and parenchymal area/pelvic area have no difference between the groups based on age,but SFU degree 4 had more significant differences than degree 3 in DRF,p=0.02. Conclusion The renal function and form have been improved significantly after pyeloplasty.Patients younger than 5 years had postoperative improvement in GFR significantly.Recovery of renal function in the affected renal unit after pyeloplasty has insignificant correlation with the operation age.SFU degree is the factor of DRF.Parenchymal area/pelvic area shows higher correlation with follow-up period.