CTU术前诊断及术后疗效观察小儿先天性肾盂输尿管连接部梗阻的临床价值

Clinical Evaluation of CTU in Preoperative Diagnosis of Ureteropelvic Junction Obstruction (UPJO) and Observation for Postoperative Therapeutic Effect in Children

目的 :评价CTU检查小儿先天性UPJ梗阻术前诊断及术后疗效观察的价值。材料和方法 :对IVU检查不显影或IVU、BUS诊断不明确及临床高度怀疑泌尿道畸形患儿行CTU检查。结果 :重度肾积水 43只 ,CTU、IVU及BUS术前对其梗阻部位诊断的手术符合率分别为 98%、2 1%及 6 3%。术后肾实质厚度净增长中度肾积水为 0 .2 1± 0 .16 ,重度肾积水为0 .38± 0 .19,说明术后肾实质厚度净增长重度肾积水大于中度肾积水 ;手术前后肾盂显影时间分布构成比表明 ,术后肾分泌及排泄功能也明显改善。结论 :CTU检查适用于先天性尿路梗阻伴肾功能损伤的患儿 ,特别是UPJ梗阻患儿术前术后的检查 ,CTU可作为IVU不显影或BUS诊断不明确的一种极好的替代手段。

Purpose:To assess the value of CTU in the diagnosis of pediatric congenital UPJO before operation, and in the effect after operation. Materials and Methods: CTU examination was performed in the pediatric patients if we found that the pyelic display were not found by IVU ,and the diagnoses were not clear with IVU and BUS or the urinary malformation were highly suspected. Results: In 43 severe kidneys hydronephrosis, the accurate rates of CTU, IVU and BUS for the diagnoses of UPJO were 98%,21%,and 63% respectively. After operation, the net increase of renal parenchyma thickness in moderate hydronephrosis was 0.21±0.16; and 0.38 ±0.19 in severe hydronephrosis (P<0.05). This result indicated that net increase of renal parenchyma thickness with severe hydronephrosis was higher than that with moderate hydronephrosis after operation. There was a significant difference for the proportion of time distribution of pyelic display before and after operation (P<0.05).This showed that the renal secretion and excretion function were much improved. Conclusion: CTU examination is suitable for the pediatric congenital urinary troact obstruction with renal function damage especially for the pre-and post-operative examinations in pediatric UPJO patients. It is a good alternative method for those patients whose pyelic development is not displayed by IVU or whose diagnoses are not clear with BUS.