利尿肾动态显像联合超声检查对肾盂输尿管连接部狭窄患儿肾盂成形术手术时机选择和术后疗效评价的临床价值

Predictive value of diuretic renal scintigraphy combined with renal ultrasound for pyeloplasty in child with UPJO

目的探讨利尿肾动态显像联合泌尿系统超声多参数分析对肾盂输尿管连接部狭窄(UPJO)患儿肾盂成形术手术时机选择和术后疗效评价的临床价值。方法回顾性分析2016年1月至2020年1月于首都医科大学附属北京友谊医院核医学科行利尿肾动态显像并常规随访至少2次的84例患儿,随访6~12月。以患儿是否手术作为结局事件将患儿分为手术组(68例)和非手术组(16例),对比分析两组患儿的利尿肾动态显像[分肾功能(DRF)、肾皮质通过时间(PTT)、对呋塞米的反应情况(RFS)及半排时间(T1/2)]及泌尿系超声肾盂前后径(APD)。结果手术组患儿的PTT延迟、RFS<50%患儿明显多于非手术组(P<0.05);手术组患儿的APD明显高于非手术组[(3.2±1.7) cm vs.(1.9±1.1) cm],差异具有统计学意义(P<0.05)。Logistic回归分析显示,PTT延迟、RFS<50%及APD>20 mm是UPJO患儿肾盂成形术的预测因素。结论利尿肾动态显像能够反映DRF及RFS情况,泌尿系统超声反映肾盂扩张程度,将两者联合将有助于对单侧UPJO患儿手术时机选择及术后疗效评价有重要意义。当PTT延迟、RFS<50%且APD>20 mm时,应尽早对单侧UPJO患儿行肾盂成形术,以防止肾功能进一步恶化。

Objective To explore the predictive value of diuretic renography combined with urinary ultrasound for pyeloplasty in children with UPJO.Methods 84 children who was diagnosed as unilateral UPJO were retrospectively collected.All included patients underwent diuretic renography and ultrasound between January 2016 and January 2020.The follow-up interval was 6 ~ 12 months.The children were divided into the surgical group(n = 68) and the non-surgical group(n = 16),and the diuretic renography results(differential renal function(DRF),parenchymal transit time(PTT),response to furosemide stimulation(RFS) and T1/2) and anteroposterior diameter(APD) measured by urinary ultrasound were compared between the two groups.Results The PTT delay and RFS< 50% of the children in the surgical group were significantly more than those in the non-surgical group(P< 0.05).APD in the surgical group was significantly higher than that in the non-surgical group[(3.2 ±1.7) cm vs(1.9 ±1.1) cm].Logistic regression analysis showed that PTT delay,RFS<50% and APD >20 mm were predictive factors for pyeloplasty in children with UPJO.Conclusion Diuretic renography may reflects the split renal function and upper urinary drainage.The urinary ultrasound reflects the dilation of renal pelvis.Combination of the diuretic renography and ultrasound will help to decide the surgical intervention and conservative follow-up in children with UPJO.PTT delay,RFS< 50% and APD >20 mm were the predictive factor for the need of surgery in children with unilateral UPJO to prevent further deterioration of renal function.