后尿道瓣膜中pop-off现象对肾功能及膀胱功能的影响

Effects of pop-off mechanisms upon renal and bladder function of children with posterior urethral valve

目的探讨合并pop-off现象对后尿道瓣膜患儿肾功能及膀胱功能的影响。方法回顾性分析2005年1月至2015年12月首都医科大学附属北京儿童医院泌尿外科收治并获得长期随访的15例后尿道瓣膜患儿的病例资料,依据是否合并pop-off现象将获得随访的患儿分为pop-off组(6例)和无pop-off组(9例)。依据血清肌酐值(入院时、初次引流后1年内最低值)评估肾功能;结合泌尿系超声和静脉肾盂造影评估上尿路积水情况,排尿性膀胱尿道造影评估膀胱输尿管反流情况;下尿路症状及尿动力学检查评估膀胱功能。结果pop-off组与无pop-off组入院时血清肌酐值分别为(76.03±67.77)μmol/L和(82.83±107.09)μmol/L,pop-off组与无pop-off组初次引流后血清肌酐最低值分别为(43.80±21.60)μmol/L和(44.11±20.72)μmol/L;组间差异均无统计学意义(P>0.05)。两组后尿道瓣膜患儿均未发生肾功能不全或衰竭等肾脏终点事件。pop-off组患儿中4例术后出现下尿路症状,无pop-off组患儿中7例术后出现下尿路症状。尿动力学检查结果显示:15例患儿中14例存在不同程度的膀胱功能异常。pop-off组与无pop-off组患儿最大膀胱测压容量分别为(138.3±96.2)ml和(152.1±90.4)ml;pop-off组与无pop-off组患儿膀胱顺应性分别为(8.04±8.94) ml/cmH2O和(12.11±11.73)ml/cmH2O;逼尿肌不稳定者pop-off组3例,无pop-off组4例;pop-off组与无pop-off组患儿逼尿肌漏尿点压力分别为(49.83±25.72)cmH2O和(42.22±22.47)cmH2O;pop-off组与无pop-off组患儿残余尿量分别为(22.33±33.77)ml和(16.89±25.83)ml。最大膀胱测压容量、膀胱顺应性、逼尿肌漏尿点压力、逼尿肌不稳定和残余尿量,组间差异均无统计学意义(P>0.05)。结论pop-off现象对后尿道瓣膜患儿的肾功能及膀胱功能并无保护作用。

Objective To explore the effects of pop-off mechanisms upon renal and bladder function in posterior urethral valve (PUV) after valvular ablation in children. Methods Retrospective reviews were conducted for the medical records of 15 boys diagnosed with PUV between 2005 and 2015. They were divided into those with and those without pop-off mechanisms. Serum creatinine levels at admission and nadir were employed for evaluating renal function. Ultrasound and intravenous pyelography (IVP) were utilized for gauging the severity of hydronephrosis. Clinical symptoms, voiding cystourethrogram (VCUG) and urodynamics were recorded and analyzed. Results The inter-group difference of serum creatinine at admission was insignificant (76.03±67.77 vs 82.83±107.09, P>0.05). And the difference of nadir creatinine was also insignificant (43.80±21.60 vs 44.11±20.72, P>0.05). Neither patients with pop-off mechanism nor those without it developed into chronic kidney disease or renal failure. Four (66.7%) and 7 cases (77.8%) with clinical symptoms were present in pop-off and non-pop-off groups respectively. Urodynamic results showed the inter-group differences in maximal bladder capacity (138.3±96.2 vs 152.1±90.4, P>0.05);bladder compliance (8.04±8.94 vs 12.11±11.73, P>0.05);3 cases (50%) with detrusor instability (DI) in pop-off group, 4 DI cases (44.4%) in non-pop-off group;detrusor leak-point pressure (49.83±25.72 vs 42.22±22.47, P>0.05);residual urine was insignificant (22.33±33.77 vs 16.89±25.83). None of the above parameters had any statistically significant inter-group difference (P>0.05). Conclusions The pop-off mechanism has no protective effect on renal and bladder function.