Clinical analysis of percutaneous nephrostomy combined with delayed laparoscopic pyeloplasty in the treatment of severe hydronephrosis with renal function less than 10%
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摘要: 目的 探讨经皮肾造瘘术(PCN)并延期腹腔镜肾盂成形术(LP)治疗儿童肾盂输尿管连接部梗阻(UPJO)分肾功能(SRF) < 10%重度肾积水的疗效。方法 收集2018年1月—2021年8月在郑州大学附属儿童医院接受治疗的单侧重度肾积水患儿的临床资料。男12例，女4例；年龄4~116个月，平均24.6个月；左侧12例，右侧4例。所有患儿均行经皮肾穿刺造瘘术，PCN术后4~8周再次行利尿肾图检查。14例肾功能改善(SRF>10%，引流尿量>400 mL/d)，12例行腹腔镜离断式肾盂成形术，其中4例同期行肾折叠，其余2例行腹腔镜肾盂瓣肾盂成形术。分别于术后3个月、6个月、1年行超声及尿常规检查，1年后行CTU检查。结果 14例(87.5%)经PCN引流后肾功能改善，SRF上升至(27.97±4.55)%，行腹腔镜肾盂成形术，其余2例行肾切除术。平均随访(25.92±6.93)个月，CTU检查显示上尿路通畅，无高血压及尿路感染。结论 通过PCN引流观察肾积水的可恢复性，然后保留的肾脏行腹腔镜肾盂成形术是治疗儿童UPJO所致肾功能不全的有效方法。
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关键词:
- 肾积水 /
- 肾造瘘术 /
- 腹腔镜肾盂成形术 /
- 肾盂输尿管连接部梗阻 /
- 肾功能
Abstract: Objective To evaluate the efficacy of percutaneous nephrostomy(PCN) and delayed laparoscopic pyeloplasty(LP) in the treatment of severe hydronephrosis in children with ureteropelvic junction obstruction(UPJO) and split renal function(SRF) < 10%.Methods In this retrospective analysis, we included patients who underwent PCN for unilateral UPJO of the kidneys with hydronphrosis and split renal function < 10% at Children's Hospital Affiliated to Zhengzhou University between January 2018 and August 2021. There were 12 boys and 4 girls, and the mean age was 24.6 months(ranged from 4 months to 116 months). All the children underwent PCN, and then they underwent repeated diuretic renography 4-8 weeks later. Fourteen cases had improved renal function(SRF>10%, urine output>400 mL/d). Twelve cases underwent laparoscopic pyeloplasty, of which 4 cases underwent renal folding at the same time, and the other 2 cases underwent laparoscopic pelvis flap pyeloplasty. The patients were followed up with ultrasound and urine routine at 3 and 6 months, 1 year, and CTU was performed 1 year later.Results Fourteen of 16 kidneys with unilateral UPJO improved after PCN drainage and laparoscopic pyeloplasty. In the patients with unilateral UPJO who improved after PCN drainage, the SRF increased to(27.97±4.55)% and pyeloplasty was performed. The 2 kidneys that did not show improvement in the SRF underwent nephrectomy. During a mean follow-up period of(25.92±6.93) months, none of these patients had developed hypertension, and CTU examination showed that the upper urinary tract was unobstructed.Conclusion Observing the recoverability of hydronephrotic kidneys via PCN drainage, then performing laparoscopic pyeloplasty for preserving selected kidneys may be an effective method for managing poorly functioning kidneys due to UPJO. -
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表 1 16例重度肾盂积水患儿一般临床资料
病例 年龄/月 性别 侧别 临床表现 肾盂前后径/mm 肾动态/% 肾皮质厚度/mm 尿比重 尿肌酐/(μmol·L-1) 术前 术后 造瘘前 造瘘后 造瘘前 造瘘后 造瘘后24 h内 造瘘后 造瘘后24 h内 造瘘后 1 10 男 右 体检 67.9 15.9 5.27 22.78 1.8 3.7 0.981 1.014 307.4 512.12 2 4 男 左 产前 39.4 13.7 8.12 30.86 2.0 4.7 0.991 1.012 544.94 670.48 3 18 男 左 体检 68.7 25.8 7.68 29.37 1.8 4.8 0.998 1.021 407.86 541.7 4 13 女 左 腹部肿物 65.2 19.5 8.82 25.12 2.2 5.2 1.011 1.025 571.46 789.28 5 9 男 左 体检 56.3 11.6 8.32 28.57 2.1 4.5 0.992 1.012 577.30 773.88 6 58 男 左 腹痛 71.6 20.3 5.06 19.89 1.6 4.0 0.988 1.011 270.82 521.43 7 7 男 右 产前 58.4 18.7 9.13 38.01 2.2 5.3 1.015 1.016 584.34 743.63 8 16 男 左 腹部肿物 65.5 26.7 6.37 25.78 1.9 4.8 0.989 1.014 398.60 525.64 9 12 男 右 体检 62.6 18.9 7.95 31.16 2.1 5.6 1.023 1.025 477.38 651.27 10 26 女 左 腹部肿物 68.9 - 5.53 8.06 1.1 2.3 0.992 - 324.78 - 11 4 女 左 产前 52.3 14.2 8.77 31.98 1.8 4.6 1.017 1.024 582.95 798.72 12 86 男 左 腹痛 88.8 - 4.16 7.39 0.8 2.0 0.985 - 311.28 - 13 19 男 左 腹部肿物 66.3 23.5 6.52 24.87 1.7 4.5 0.982 1.018 406.71 621.58 14 116 男 右 腹部肿物 76.4 26.7 6.47 24.71 2.0 4.4 0.989 1.016 351.69 567.64 15 14 男 左 体检 67.6 24.4 5.42 24.67 1.7 4.2 0.986 1.015 364.98 530.74 16 11 女 左 体检 64.7 19.3 7.36 28.65 1.6 4.5 0.992 1.010 334.57 498.11 
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表 2 LP组患侧PCN前后肾功能结果的比较
X±S 项目 SRF/% 肾皮质厚度/mm 尿比重 尿肌酐/(μmol·L-1) 肾造瘘前 7.23±1.38 1.89±0.21 0.997±0.003 441.50±112.45 肾造瘘后 27.97±4.55 4.63±0.51 1.016±0.001 624.73±112.57 P值 < 0.001 < 0.001 < 0.001 < 0.001
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