Surgical timing and efficacy of moderate hydronephrosis in children with unilateral ureteropelvic junction obstruction
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摘要: 目的 回顾性分析在我中心住院并接受手术治疗的80例诊断为肾盂输尿管连接处梗阻(UPJO)的患儿，探讨肾盂前后径(APD)在1.5~2.0 cm的中度肾积水患儿手术时机的选择及疗效分析。方法 分析2013年7月—2021年7月我院收治的80例单侧UPJO且初诊APD在1.5~2.0 cm的先天性肾积水患儿的临床资料。根据手术时的年龄将儿童分为2组：≤1岁组(34例)，>1岁组(46例)。比较肾盂输尿管成形术前后超声测量的实质厚度、APD和肾动态显像扫描测量的肾功能变化。结果 ≤1岁组手术前后肾实质厚度、APD、分肾功能比较，差异均有统计学意义(P < 0.05)。>1岁组手术前后肾实质厚度、APD、分肾功能比较，差异均有统计学意义(P < 0.05)。2组在术后肾实质厚度、分肾功能方面差异有统计学意义(P < 0.05)。进一步多因素回归分析发现肾实质厚度(HR=1.765，P=0.034)和手术时年龄(HR=0.585，P=0.001)是术后分肾功能改善>5%的预测指标。结论 对于初诊APD在1.5~2.0 cm的先天性肾积水患儿应早期行手术治疗，以避免肾脏形态和肾功能的进一步损伤。手术时患儿年龄和肾实质厚度可预测肾盂输尿管成形术后的效果。
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关键词:
- 先天性肾盂输尿管连接处梗阻 /
- 肾盂前后径 /
- 手术时机
Abstract: Objective This study retrospectively analyzed 80 children diagnosed with ureteropelvic junction obstruction (UPJO) who underwent surgical treatment in our center, and discussed the choice of surgical timing and efficacy in children with moderate hydronephrosis whose anteroposterior pelvic diameter (APD) is between 1.5 cm and 2.0 cm.Methods The 80 congenital hydronephrosis children with unilateral UPJO and APD in the range of 1.5-2.0 cm admitted to our hospital from July 2013 to July 2021 were retrospectively analyzed. Children were divided into two groups according to their age at surgery, ≤1 year old group (n=34), and > 1 year old group (n=46). Parenchymal thickness, APD and differential renal function measured by dynamic renal imaging were compared before and after pyeloplasty.Results There were significant differences in parenchymal thickness, APD and renal function before and after pyeloplasty in ≤1 year old group (P < 0.05). There were also significant differences in renal parenchymal thickness, APD and renal function before and after pyeloplasty in > 1 year old group (P < 0.05). Patients in ≤1 year old group who underwent pyeloplasty within 1 year of birth, showed significant recovery of parenchymal thickness and renal function compared with those in > 1 year old group (P < 0.05). Further multivariate regression analysis showed that parenchymal thickness (HR=1.765, P=0.034) and age at surgery (HR=0.585, P=0.001) were the predictors of postoperative renal function improvement.Conclusion Early pyeloplasty should be performed to avoid further damage of renal morphology and renal function for children with congenital hydronephrosis with APD of 1.5-2.0 cm. Age at surgery and parenchymal thickness could predict the outcome of pyeloplasty. -
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表 1 2组患儿一般资料及术前指标
X±S 指标 ≤1岁组(34例) > 1岁组(46例) χ2/Z P值 性别/例 0.068 0.794 男 25 35 女 9 11 患肾部位/例 0.011 0.917 左 29 38 右 5 8 初诊症状/例 0.668 0.414 有 23 27 无 11 19 手术方式/例 0.108 0.742 开放 10 11 腹腔镜 24 35 DRF/% 42.30±3.45 41.20±2.89 1.549 0.125 APD/cm 1.86±0.13 1.88±0.11 0.859 0.393 PT/cm 0.46±0.15 0.52±0.23 1.411 0.162 
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表 2 2组患儿术后指标比较
X±S 指标 ≤1岁组(34例) > 1岁组(46例) Z P值 手术时年龄/月 7.92±1.98 68.80±14.81 APD/cm 1.959 0.053 术前 1.86±0.13 1.88±0.11 术后 1.02±0.251) 1.12±0.231) APD差异 0.84±0.15 0.76±0.20 PT/cm 5.332 < 0.001 术前 0.46±0.15 0.52±0.23 术后 0.95±0.241) 0.81±0.261) PT差异 0.49±0.16 0.29±0.17 DRF/% 3.480 < 0.001 术前 42.3±3.45 41.2±2.89 术后 48.9±5.691) 46.3±4.511) DRF差异 6.6±1.32 5.1±2.24 与术前比较，1) P < 0.05。
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表 3 多因素回归分析术前指标与术后肾功能改善的关系
因素 HR 95% CI P值 手术年龄 ≤1岁 1 > 1岁 0.585 0.419~0.802 0.001 性别 男 1 女 0.947 0.687~1.280 0.735 APD 1.50~1.75 cm 1 1.75~2.00 cm 1.243 0.897~1.586 0.658 PT ≤0.5 cm 1 > 0.5 cm 1.765 1.541~1.924 0.034
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