婴儿先天性梗阻性肾病术后^(99)Tc^m-EC利尿肾动态显像

Diuretic renography in neonates and infants with congenital obstructive hydronephrosis for evaluating postoperative renal function

目的 探讨利尿肾动态显像 (DR)评价婴儿先天性梗阻性肾病术后肾功能的价值。方法 32例术前确诊为先天性梗阻性肾病合并积水的患儿 ,术后行 1～ 4次DR复查。术后患肾功能的定性评估结合双肾形态、肾图及各项功能指标综合分析。单肾积水术后患肾功能定量评估以患肾血流灌注率 (BPR)为指标。结果 定性评估单个肾术后共 6 7次DR检查中肾功能的转归 ,完全好转 6次 (9 0 % ) ,明显好转 35次 (5 2 2 % ) ,好转 7次 (10 4 % ) ,不变 9次 (13 4 % ) ,恶化 10次 (14 9% )。各组BPR变化值差异有极显著性 (F =7 77,P <0 0 0 1) ;术后肾功能变化的定性与定量评估结果差异无显著性 (χ2 =0 0 17,P =0 897)。肾重复畸形术后转归较好。在影响单肾积水术后BPR提高的因素中 ,BPR提高与术前患肾面积比呈正相关 (r=0 5 5 2 ,P <0 0 5 ) ,与术前BPR值呈负相关 (r =0 85 2 ,P <0 0 0 1) ,与手术时年龄和随访间隔无相关性 (r=0 0 11,0 16 6 ,P均 >0 0 5 )。结论 DR评价婴儿先天性梗阻性肾病术后肾功能有较好的应用价值。

Objective To study the value of diuretic renography (DR) in evaluation of renal function after operation in congenital obstructive hydronephrosis (HN) in neonates and infants. Methods Thirty two patients with the disease detected in their neonatal or infantile period were submitted to this study. DR was performed 1 to 4 times on all patients during follow up. The qualitative evaluation of renal function after operation was combined with renal morphology, renogram curve and several other renal function indexes. The major index of quantitative evaluation of renal function is the change of renal blood perfusion rate (BPR). Results The results of qualitative evaluation with 67 DR in the affected kidney (AK): 6 totally recovered, 35 significantly improved, 7 improved, 9 unchanged, 10 deteriorated. The changes of BPR of the groups with qualitative evaluation differed from each other significantly( F =7.77, P <0.001). There was no significant difference between the results of qualitative evaluation and quantitative evaluation. The function of duplex kidney was well improved after operation. The increasing of BPR was positively correlated with the preoperative AK area ratio ( r =0.552, P <0 05), and negatively correlated with the preoperative BPR( r =0.852, P <0.001), but not correlated with the age while the operation was performed and the length of follow up ( r=0.011, P >0.05 and r =0.166, P >0.05, respectively). Conclusion The change of BPR is a good index of renal function after operation, but only the quantitative evaluation being combined with qualitative evaluation can be considered a complete evaluation.