Selection of the operation timing for hydronephrosis caused by UPJO using the anteroposterior diameter of the renal pelvis as a reference
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摘要: 目的探讨肾盂前后径(APD)在1.5~2.0 cm的小儿先天性肾积水手术时机的选择。方法回顾性分析新疆医科大学第一附属医院2018年1月—2020年1月收治的60例因单侧UPJO导致的先天性肾积水患儿的临床资料。将其分为两组：A组(30例)，APD达到1.5~2.0 cm时立即行手术治疗；B组(30例)，APD达到1.5~2.0 cm时给予详细解释后根据家属意愿继续随访观察，其中26例随访过程中病情进一步发展(APD>2.0 cm)行手术治疗，4例出现临床症状后(腹痛、泌尿道感染)行手术治疗。60例患儿均行腹腔镜下或开放性小切口离断性肾盂输尿管成形术，采用彩色多普勒泌尿系超声和肾动脉显像(SPECT)分析两组术后24个月肾脏形态(APD、肾实质厚度)和肾功能(分肾功能)恢复情况。结果与术前比较，术后24个月A、B组APD均显著缩小[A组：(17.12±2.52) mm vs. (10.06±1.25) mm；B组：(23.59±3.09) mm vs.(13.26±1.68) mm]，肾实质厚度显著增加[A组：(5.79±0.61) mm vs.(9.66±0.65)mm；B组：(3.82±0.91) mm vs.(5.93±0.61) mm]，分肾功能显著改善[A组：(45.55±1.13)% vs.(57.65±0.65)%；B组：(26.65±0.53)% vs.(38.89±0.68)%]，且术后24个月A组APD、肾实质厚度及分肾功能恢复程度均优于B组(均P < 0.05)。结论对于通过泌尿系B超测得APD在1.5~2.0 cm的先天性肾积水患儿应早期行手术治疗，避免肾脏形态和肾功能不可逆性损伤，提高患儿的生活质量。Abstract: ObjectiveTo explore the selection of surgical timing for children with congenital hydronephrosis whose anterior posterior diameter of renal pelvis(APD) is in the range of 1.5-2.0 cm.MethodsThe clinical data of 60 children with congenital hydronephrosis caused by unilateral UPJO who were admitted in The First Affiliated Hospital of Xinjiang Medical University from January 2018 to January 2020 were retrospectively analyzed. They were divided into two groups: group A (n=30), surgery was performed immediately when the APD reached 1.5-2.0 cm; Group B (n=30), after the APD reached 1.5-2.0 cm, detailed explanations were given, and follow-up observation was continued according to the wishes of the family members. Twenty-six patients in group B developed further(APD>2.0 cm) during follow-up and received surgical treatment. Other four patients had clinical symptoms(abdominal pain, urinary tract infection) and received surgical treatment. All 60 patients underwent laparoscopic or open small incision dismembered ureteropelvioplasty. Color Doppler ultrasonography and renal artery imaging were used to analyze the recovery of renal morphology(APD, renal parenchyma thickness) and renal function(sub-renal function) 24 months after operation in the two groups.ResultsCompared with those before operation, APD in the Group A and B decreased significantly 24 months after operation[Group A: (17.12±2.52) mm vs. (10.06±1.25) mm; Group B: (23.59±3.09) mm vs. (13.26±1.68) mm], renal parenchyma thickness increased significantly[Group A: (5.79±0.61) mm vs. (9.66±0.65)mm; Group B: (3.82±0.91) mm vs. (5.93±0.61) mm], and sub-renal function was significantly improved[Group A: (45.55±1.13)% vs. (57.65±0.65)%; Group B: (26.65±0.53)% vs. (38.89±0.68)%], and the recovery of APD, renal parenchyma thickness and sub-renal function in Group A were better than those in Group B 24 months after operation(all P < 0.05).ConclusionEarly surgical treatment should be performed for children with congenital hydronephrosis with APD in the range of 1.5-2.0 cm measured by urinary B-ultrasound to avoid irreversible damage to renal morphology and function, and to improve the quality of life of children.
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表 1 A、B组手术前后APD、肾实质厚度和分肾功能比较
X±S 时间 A组(30例) B组(30例) APD/mm 肾实质厚度/mm 分肾功能/% APD/mm 肾实质厚度/mm 分肾功能/% 术前 17.12±2.52 5.79±0.61 45.55±1.13 23.59±3.09 3.82±0.91 26.65±0.53 术后3个月 15.04±1.56 7.01±0.58 50.83±0.56 19.23±2.06 4.34±0.35 31.21±0.75 术后6个月 13.98±1.88 7.87±0.88 53.35±0.64 17.36±1.97 4.94±0.65 34.98±0.81 术后12个月 12.05±1.84 8.97±0.69 55.90±0.84 15.56±1.26 5.48±0.43 36.56±0.63 术后18个月 11.81±0.95 9.05±0.26 56.12±0.67 14.78±1.04 5.74±0.25 37.27±0.45 术后24个月 10.06±1.251) 9.66±0.651) 57.65±0.651) 13.26±1.681)2) 5.93±0.611)2) 38.89±0.681)2) 与术前比较，1)P < 0.05；与A组术后24个月比较，2)P < 0.05。 
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