胎儿肾积水的产前诊断及产后干预探讨

Causes of Fetal Hydronephrosis and Prognosis Analysis

目的探讨胎儿肾积水的病因、产前诊断及预后情况。方法2007年7月至2014年2月经本院产前超声检查诊断为胎儿肾积水的患儿131例，其中单侧89例，双侧42例。按不同胎龄及肾盂前后径（APD）将其分类，并在儿外科一直随诊至2 岁。结果131例患儿中，72例（54．96％）出生后3个月超声检查获自愈；45例（34．35％）有明显好转；7例（5．34％）稍有好转；4例（3．05％）无明显变化；3例（2．30％）加重；出生后6个月时超声检查，45例明显好转的病例自愈，7例稍有好转的病例中4例自愈，3例有进一步好转，随诊至1岁也自愈；4例无变化和 3例加重患儿分别给予手术治疗，随诊至3岁。结论胎儿肾积水的病因复杂多样，临床分为生理性和病理性，预后差别较大。

Objective Studies the causes,prenatal diagnosis and prognosis analysis of fetal hydrone-phrosis. Methods To study the causes,prenatal diagnosis and prognosis analysis of fetal hydronephrosis. Method A total of 131 cases of fetal hydronephrosis （including 89 cases of unilateral hydronephrosis and 42 ca-ses of bilateral hydronephrosis）detected throughprenatal ultrasound diagnosis at the obstetrics department of our hospital during the period from July 2007 to February 2014 were analyzed retrospectively and classified based on gestational age and the anteroposterior diameter （APD）.The cases were then followed up by the pediatric surgery department until after two years of birth. Results Ultrasonic inspection upon three months of birth showed 72 cases （54.96%）of self cure,45 cases （34.35%）of major improvement,7 cases （5.34%）of mi-nor improvement,4 cases （3.05%）of no visible change and 3 cases （2.30%）of aggravation.Ultrasonic in-spection upon six months of birth revealed that all 45 cases with obvious improvement during the first ultrasonic inspection were recovered.Of all the 7 cases that showed minor improvement during the first inspection,4 re-covered and the other 3 improved further and later fully recovered after one year of birth based on periodic checks.Further,surgery treatments were given to all four cases of no visible change and three cases of aggrega-tion,and their improvement status was followed up until after three years of birth. Conclusions The causes of fetal hydronephrosis are varied and complicated,including physiological causes and pathological causes clinically.The prognosis also varies greatly.