胎儿肾积水的超声分级与预后相关分析

Analysis of relationship between ultrasound grading of fetal hydronephrosis and prognosis

目的利用超声检查对肾积水胎儿的妊娠结局和预后进行评估,为临床诊断提供帮助。方法对孕中晚期经超声检查确定的肾积水胎儿124例（140只肾）,按肾盂扩张的前后径、肾盏形态和肾皮质厚度分为Ⅰ~Ⅴ级组,随访妊娠结局和转归。结果 （1）Ⅰ级、Ⅱ级、Ⅲ级、Ⅳ和Ⅴ级肾积水胎儿的引产率分别是3.45%、11.75%、26.32%、75.00%和100.00%（χ2=51.062,P=0.000）。（2）在正常分娩的胎儿中,Ⅰ级、Ⅱ级、Ⅲ级和Ⅳ级肾积水产前好转率分别为87.69%、69.44%、46.67%和0.00%,产后好转率分别为12.31%、25.00%、33.33%和50.00%,需手术治疗率分别为0.00%、5.56%、20.00%和50.00%（χ2=23.382,P=0.000）。结论产前超声检查能在一定程度上评估肾积水胎儿的妊娠结局和预后,具有较高的临床诊断价值。

Objective To evaluate the pregnancy outcome and prognosis of fetuses with hydronephrosis by ultrasonography,then to provide help for clinical intervention.Methods Totally 124fetuses（140kidneys）with hydronephrosis received ultrasonography at pregnancy period.They were divided into five groups,gradeⅠ,Ⅱ,Ⅲ,Ⅳ and Ⅴaccording to the renal pelvis anteroposterior diameter（APD）,morphology of renal calyces and renal parenchyma thickness.Pregnancy outcome were followed up.Results（1）The rate of induced labor in gradeⅠ,Ⅱ,Ⅲ,ⅣandⅤgroup was3.45%,11.75%,26.32%,75.00% and 100.00%（χ2=51.062,P=0.000）,respectively.（2）Among the normal birth fetasus,in gradeⅠ,Ⅱ,Ⅲ,Ⅳ group,the prenatal improvement rate was 87.69%,69.44%,46.67%and 0.00%,the postpartum improvement rate was 12.31%,25.00%,33.33% and 50.00%,and the rate of operation treatment was0.00%,5.56%,20.00% and 50.00%,respectively（χ2=23.382,P=0.000）.Conclusion The prenatal ultrasonography is of great value in judging the pregnancy outcome and prognosis of fetuses with hydronephrosis.