超声诊断妊娠中期胎儿单纯肾盂扩张及产前宫内动态随访

Diagnosis of isolated fetal renal pyelectasis during midtrimester and follow-up the outcome in utero by prenatal uitrasonography

目的探讨超声诊断胎儿肾盂扩张的临床意义及产前肾盂宽度的变化趋势。方法回顾性分析中期妊娠行超声筛查大畸形的14255例孕妇中检出胎儿肾盂前后径宽度（renal pelvis anteroposterior diameter，RPAPD）≥5mm且无其他合并畸形的197例胎儿的影像资料。依据中期妊娠筛查肾盂扩张结果分为2组：A组，RPAPD5～10mm；B组，RPAPD≥10mm。随访复查至分娩前，32周至分娩的复查结果分为2组：C组，RPAPD％10mm；D组，RPAPD≥10mm。结果中期妊娠筛查A组188例（95．4％），其中失访41例，随访至分娩前，141例（95．9％）RPAPD〈10mm，6例（4．1％）RPAPD≥10mm；B组9例（4．6％），失访2例，7例持续扩张至分娩前。分娩前随访结果C组141例（91．6％），D组13例（8．4％）。结论中期妊娠超声诊断单纯胎儿肾盂扩张（RPAPD5～10mm）的患者大部分在分娩前RPAPD〈10mm，而RPAPD≥10mm的患者在分娩前持续性进行性扩张。产前超声动态监测胎儿肾盂宽度，能够及时准确地提供产前咨询信息。

Objective To assess the clinical significance of fetal pyelectasis and its changing in utero. Methods One hundred and ninty-seven isolated pyelectasis cases were retrospective reviewed from Jan 2012 to Jul 2014. Isolated pyelectasis was defined as a renal pelvis anteroposterior diameter （RPAPD） of ≥5 mm without other fetal anomaly in second trimester. Persistent or progressive pyelectasis was defined as a RPAPD of ≥10 mm before delivery. They were divided into two groups according to the size of renal pelvis in second trimester：group A （RPAPD 5- 10 mm） and group B （RPAPD ≥10 mm）. As the same,there were two groups after 32 weeks of gestation： group C （RPAPD 〈10 mm） and group D （RPAPD ≥10 mm）. Results Totally 154 cases were followed up. There were 188 eases （95.4%） in group A,with 41 cases lost,141 cases （95.9M） RPAPD 〈10 ram,6 cases （4.1%） RPAPD ≥10 mm before delivery. There were 9 cases （4.6%） in group B, with 2 cases lost, remained 7 cases RPAPD ≥10 mm before delivery. Conclusions Although most of the fetuses with RPAPD 5 - 10 mm in second trimester will remain the same or resolved before delivery, those with RPAPD≥ 10 mm may persistent or progress. Prenatal assessment of fetal renal pelvis may provide properly consultation.