新生儿肾积水

目的　探讨新生儿肾积水盂管交界处狭窄段的病理变化、手术及保守治疗的指征。方法　总结 10例新生儿肾积水的治疗。 10例均行B超、IVU或CTU、ECT检查。 7例 8个肾因肾盂及肾盏明显扩张、肾功能中至重度损害 ,行切除盂管狭窄段、肾盂成形及肾盂输尿管吻合手术治疗 ,切除的盂管狭窄段行病理及超微结构观察 ;1例由输尿管末端囊肿引起的肾积水 ,经膀胱行输尿管囊肿开窗术 ;另 3例肾积水较轻 ,肾功能正常或轻度受损 ,未手术只行长期观察随访。结果　 7例手术患儿术后恢复顺利 ,术后随访 3个月～ 3年 ,肾积水减轻 ,肾功能明显改善。病理检查 ,见管腔内上皮细胞无明显变化 ,管壁平滑肌细胞排列紊乱、退化、变性 ,细胞间隙增大 ,管壁内有大量胶原纤维增生致管腔狭窄。 3例观察随访的患儿无明显变化。结论　①对肾盂轻度扩张 (肾盂直径 <12mm) ,肾功能正常或接近正常 (相对肾功能大于 4 0 % )的患儿 ,可随访观察 ;②对肾盂扩张 ,积水程度严重 (中～重度 ) ,肾功能受损 ;或在观察治疗过程中 ,肾功能进行性减退的患儿 ,应行手术治疗 ,这类患儿多已存在不可逆的病理组织变化

Hydronephrosis in newborns

Objective To investigate the pathologic changes in ureteropelvic junction (UPJ) obstruction, indications of surgical intervention and conservative treatment in neonatal hydronephrosis. Methods From May 1999 to April 2002, the diagnosis of 10 newborns with hydronephrosis were confirmed by ultrasonogram, IVU or CTU and ECT examinations. The cause of 10 cases (bilateral 9, unilateral 1) was UPJ stenosis and one ureterocele. Seven cases (8 kidneys) with dilated pelvis and severe renal function damage underwent stricture resection and dismembered pyeloplasty (Anderson Hynes technique), one case of ureterocele received intravesical fenestration, and the other 3 with mild pelvic dilatation and renal function damage had conservative management.The light and electronic microscopic examination demonstrated that disarrangement and degeneration of smooth muscle cells, and proliferation of collagen led to thickening and obstruction of the ureter. Results The follow up outcome from 3 months to 3 years showed that pelvic dilatation and renal function improved in 8 cases postoperatively and stable in 3 after conservative treatment. Conclusions Conservative management of UPJ is justified in most neonates with mild dilated pelvis and relative normal renal function on repeated ultrasonography or IVU. Surgical treatment should be applied to cases with increasing pelvis dilatation and declining of renal function that predicts irreversible pathologic changes of UPJ anomalies.