三维超声联合肾动脉相关血流参数对孕晚期胎儿肾盂扩张疾病预后的评估价值

The assessment value of three-dimensional volume ultrasound combined with the detection of renal artery-related blood flow parameters for fetal pyelectasis in pregnant women at late-gestation

目的探讨肾动脉相关血流参数联合三维容积超声对孕晚期胎儿肾盂扩张疾病的预后价值。方法选择2019年1月至2021年3月收治的妊娠晚期发现胎儿肾盂扩张的孕妇56例。同时根据UTD(美国泌尿系统扩张分类法)方法选取A2-A3组胎儿肾积水进行对比。根据是否伴有肾动脉相关血流参数异常分为试验组和对照组。采用三维容积超声测量肾积水体积。测量并计算受累肾动脉(RA)阻力指数(RI)同搏动指数(PI)以及S/D值。结果56例胎儿共112个肾脏,其中95个肾脏诊断为肾盂扩张。试验组为47例胎儿肾盂扩张伴有肾动脉相关血流参数异常。妊娠结局中,31例出生后选择接受手术治疗并证实存在尿路梗阻性病变,8例出生后肾盂扩张减轻或消失,8例出生后未接受手术治疗。对照组为48例单纯三维超声诊断胎儿肾盂扩张,7例出生后选择接受手术治疗并证实存在尿路梗阻性病变,36例出生后肾盂扩张减轻或消失,5例出生后未接受手术治疗。结论三维容积超声联合肾动脉相关血流参数较单纯二维超声对胎儿肾盂扩张疾病的产前咨询及预后判断更具指导价值。

Objective To investigate the assessment value of three-dimensional(3D)volume ultrasound combined with the detection of renal artery-related blood flow parameters for fetal pyelectasis in pregnant women at late-gestation.Methods A total of 56 pregnant women with fetal pyelectasis at late-gestation who were treated in our hospital from January 2019 to March 2021 were enrolled in the study,who were divided into control group and experimental group according to whether they had the abnormality of renal artery-related blood flow parameters.The fetal hydronephrosis was classified according to UTD(American urinary tract dilation classification).And renal volume was measured by three-dimensional volume ultrasound,and renal artery resistance index(RARI)and pulsatility index(PI)as well as S/D value on affected side were measured and analyzed.Results Of the 56 fetuses(112 kidneys),pyelectasis was diagnosed in 95 kidneys.There were 47 cases of fetal pyelectasis complicated by abnormal renal artery-related blood flow parameters in experimental group,In the aspects of pregnancy outcome,31 cases chose surgery after birth and were confirmed the presence of urinary tract obstructive lesions,and the renal pelvis dilatation in 8 cases was relieved or disappeared after birth,and the other 8 cases were not treated by surgery after birth.There were 48 cases of fetal renal pelvis dilatation diagnosed by simple three-dimensional ultrasound in control group,and 7 cases were treated by surgery after birth and were confirmed the presence of urinary tract obstructive lesions.Moreover the renal pelvis dilatation in 36 cases was relieved or disappeared after birth,and 5 cases were not treated by surgery after birth.Conclusion The 3D volume ultrasound combined with the detection of renal artery-related blood flow parameters is superior to simple 2D ultrasound in prenatal consultation and prognostic prediction of fetal pyelectasis in pregnant women at late-gestation.