肾盂输尿管连接部梗阻致儿童急性症状型肾积水临床特点分析

Clinical feature analysis of acute symptomatic hydronephrosis in children with ureteropelvic junction obstruction

目的探讨肾盂输尿管连接部梗阻(Ureteropelvic junction obstruction,UPJO)致儿童急性症状型肾积水的临床特点,比较其中的进行性加重型肾积水和间歇性肾积水的异同。方法回顾性分析2013年1月至2017年12月由本院收治的UPJO致急性症状型肾积水患儿临床资料,根据纳入排除标准筛选病例并主要依据术前多次泌尿系B超检查结果,将所有患儿分为进行性肾积水组和间歇性肾积水两组,对两组患儿的临床特点及随访结果进行比较分析。结果本研究共纳入92例UPJO致急性症状型肾积水患儿,其中男童83例,女童9例,左侧72例,右侧19例,双侧1例。随访时间为4个月至5年,平均3.6年。进行性肾积水组肾盂前后径变化波动范围大于间歇性肾积水组患儿,差异有统计学意义(t=3.36,P=0.02)。肾核素检查中,进行性肾积水组患肾分肾功能要低于间歇性肾积水组患儿(36.1%±13.7%vs 43.6%±6.5%),差异有统计学意义(t=2.25,P=0.03)。89例患儿均行离断性肾盂成形术,其中5例迷走血管移至肾盂输尿管后方,2例下腔静脉后输尿管行输尿管复位吻合术,1例巨大肾积水分肾功能低于10%行肾切除术。进行性肾积水组(84.0%)肾盂输尿管连接部狭窄发生率明显高于间歇性肾积水组(64.3%),差异有统计学意义(χ2=4.73,P=0.03)。而进行性肾积水组肾盂输尿管狭窄段的长度要明显短于间歇性肾积水组患儿,差异有统计学意义[(1.66±0.62)cm vs(2.03±0.69),t=2.24,P=0.03]。结论 UPJO致儿童急性症状型肾积水的临床特点主要为反复发作并可自行缓解的腹痛。进行性肾积水和更容易被忽视的间歇性肾积水需要多次复查B超明确诊断,及时手术治疗。

Objective To explore the clinical features of acute symptomatic hydronephrosis due to uret- eropelvic junction obstruction （ UPJO） in children and compare the characteristics between progressive hydrone-phrosis and intermittent hydronephrosis. Methods The clinical data of children with acute symptomatic hydro-nephrosis due to UPJO were retrospectively analyzed from January 2013 to December 2017. According to multi-ple preoperative urological ultrasonographies,they were divided into progressive hydronephrosis group and inter- mittent hydronephrosis group. The characteristics and outcomes of two groups were analyzed. Results Among a total of 92 cases,there were 83 boys and 9 girls. The affected sides were left （n = 72） ,right （n = 19） and bilater-al （n =1） . The average follow-up period was 43.2 （4 - 60） months. The fluctuation range of anteroposterior di-ameter of renal pelvis in the progressive group was significandy higher than that in the intermittent group （ t =3.36,P =0.02） . Renal function of affected side was significandy lower in the progressive group than that the in intermittent group （36.1% ± 13.7% vs. 43.6% ±6.5% , t =2.25 ,P = 0 .0 3 ） . Among 89 patients undergoing pyel- oplasty,5 cases had renal vessels moved behind ureteropelvic junction. Two patients underwent urethroplasty for inferior vena cava while another 1 case underwent nephrectomy with renal function of impaired side below 10% due to massive hydronephrosis. The incidence of UPJO was significantly higher in the progressive hydronephrosis group than that in the intermittent hydronephrosis group （ P = 0.03 ）. The length of ureteropelvic junction stenosis was significantly shorter in progressive hydronephrosis group than that in interinittent hydronephrosis group （1.66 ± 0. 62 vs. 2. 03 ± 0.69 cm, t= 2.24 ,P =0.03 ） . Conclusion The major clinical characteristics of acute symp-tomatic hydronephrosis in children are recurrent flank pains and spontaneous remission. Those with progressive or intermittent hydronephrosis require regular ultrasonographic examinations to avoid delayed timing of surgery.