新生儿先天性肾脏和尿路发育异常的超声筛查及随访管理

目的 先天性肾脏和尿路发育异常是导致儿童慢性肾衰竭的首要原因,及早发现和诊断严重先天性泌尿系统畸形有助于防治并减少慢性肾衰的发生.本文通过在新生儿期对高危儿进行超声筛查,了解肾脏和尿路发育异常的发生情况,达到早期诊断的目的.方法 以随州市妇幼保健院为筛查中心,对高危儿行泌尿系统超声检查,对超声筛查异常者进一步检查,对符合转诊标准者转三级医院就诊,对不符合转诊者建立档案,定期随访.结果 高危儿超声筛查共479例,其中男289例（占60.33%）,女190例（占39.61%）,超声检查异常者69例（占14.4%）.超声检查异常患儿69例中男51例（占73.9%）,女18例（占26.1%）;其中肾盂积水68例,肾脏包块1例;左侧肾积水45例,右侧5例;双侧18例,4例伴左侧输尿管扩张;另有6例转诊至三级医院进行检查治疗.结论 高危新生儿期进行超声筛查可以早期发现先天性肾脏和尿路发育异常,对其进行及时干预和随访管理对防治先天性肾脏和尿路发育异常导致的儿童慢性肾衰竭有重要意义.

Ultrasound screening and management of congenital anomalies of the kidney and urinary tract in neonates

Objective Congenital anomalies of kidney and urinary tract are the leading causes of chronic kidney failure in children, and early detection and intervention of severe congenital malformation of urinary system can help to reduce the incidence of chronic renal failure in children. The present study was aimed to screen congenital anomalies of kidney and urinary tract in neonates at high risk with ultrasonography and provide information about the prevalence and follow-up and management of renal and urinary tract anomalies in infants. Methods The screening was performed on neonates at high risk with ultrasonography in Suizhou Women and Children＇s Hospital. Infants with severe abnormalities were transferred to tertiary hospitals for further evaluation, and others were managed and followed-up regularly in local hospitals. Results Total 479 high risk infants including 289 （60. 33% ） males and 190 （39. 61%） females were screened by ultrasonography. Abnormalities of the kidney and urinary tract were found in 69 （14. 4%） cases, among them there were 51 （73. 9%） boys and 18 （26. 1 %） girls. Hydronephrosis was found in 68 cases, and renal mass in one case. There were 45 cases of hydronephrosis on the left kidney, 5 cases on the right, and 18 cases on the bilateral kidney, and 4 cases of left ureteral dilatation. Six cases were transferred to a tertiary-level hospital for evaluation. Conclusions Ultrasonographic screening for early detection of congenital renal and urinary tract anomalies in neonates at high risk can find the cases with malformation at very early stage and provide information about the prevalence and follow-up and management of renal and urinary tract anomalies in infants.