术后早期PI-APD在儿童UPJO手术疗效评估中的应用价值

Prospective value of early postoperative PI-APD in children with ureteropelvic junction obstruction

目的·分析术后3个月PI-APD对于儿童肾积水手术疗效评估的作用。方法·回顾性分析上海交通大学医学院附属新华医院2012年1月—2015年11月接受手术治疗的肾积水患儿资料。根据PI-APD值将所有患儿分为3组:PI-APD≤19%组、19%<PIAPD<40%组及PI-APD≥40%组。分析术后PI-APD值与患肾分肾功能(DRF)及积水程度恢复的关系。结果·入组患儿360例,平均随访时间为20个月。术后3个月PI-APD值与患肾DRF恢复程度呈正相关(r=0.631,P=0.000)。有5例患儿术后复发,其术后早期PI-APD值均<19%。结论·PI-APD≥40%可以预示肾盂成形术后的良好结局;而PI-APD≤19%则提示手术后应密切随访,及早发现肾积水复发,避免患肾功能受损加重。PI-APD是一种可行、简单且有效的评估肾积水术后效果的客观指标。

Objective · To investigate the prospective value of early postoperative PI-APD in children with hydronephrosis. Methods · Data of children with hydronephrosis who underwent pyeloplasty in Xinhua Hospital, Shanghai Jiao Tong University School of Medicine between Jan 2012 to Nov 2015 was collected. PI-APD was divided into 3 categories （ ≤？19%, 19%〈PI-APD〈40% and ≥？40%）. The relationship between PI-APD value and the degree of renal function （DRF） and dilation recovery after surgery was analyzed. Results · There were 360 children with hydronephrosis. The median follow-up was 20 months. The PI-APD value （3 months after pyeloplasty） was positively correlated with the degree of DRF recovery （r=0.631, P=0.000）. Five patients received redo-pyeloplasty. PI-APD of all these patients was 〈19%. Conclusion · PI-APD is a new feasible ultrasound parameter in pyeloplasty followup. PI-APD ≥？40% at the first post-operative visit predicts pyeloplasty success. PI-APD ≤？19% indicates close follow-up after operation. PI-APD can also help select children at high risk for repeat intervention after pyeloplasty.