148例肾盂积水胎儿出生后的随访和治疗

目的 分析胎儿期发现肾盂积水148例患儿的出生后随访和治疗情况,初步探讨胎儿肾盂积水出生后诊断、随访方案以及手术治疗时机的选择.方法 按照美国胎儿泌尿外科协会(SFU)分级,将本院1999年1月至2006年1月收治的148例胎儿期发现肾盂积水的患儿分为4组,所有各组患儿于出生后继续B超观察随访,并辅以放射性核素扫描(ECT),磁共振水成像(MRU)等方法明确诊断,及时根据不同分级采取相应治疗方案.结果 41例1级肾盂积水的患儿持续随访1年.未出现肾盂积水加重和肾功能受损迹象,未予手术干预;49例2级患儿持续随访观察3～6个月后,其中12例因肾盂持续增大,达到3级或4级诊断标准而进行手术干预,其余37例仍持续随访观察中;31例3级和27例4级患儿均在随访观察3～6个月后出现持续肾盂增大,肾功能受损,明确诊断后进行手术干预;术后恢复良好,并分别于术后1个月、3个月、6个月、1年分别行B超随访和肾功能检查,均未再出现肾盂肾盏分离加大和肾功能继续受损趋势.结论 ①越来越多肾盂积水在胎儿期就被早期发现并被密切随访至出生后,区别于以往偶然发现,对此病诊断、治疗、随访等也应有所转变;②胎儿期肾盂积水需要区分生理性和病理性肾盂积水,进行出生后的严密随访观察和恰当治疗;③胎儿期肾盂积水出生后需根据积水级别、动态随访结果、肾功能受损情况等选择手术时机.

Postnatal treatment and follow-up for hydronephrosis in fetuses: report of 148 cases

Objective To present the experience in postnatal follow-up observation and treatment of the hydronephrosis in fetuses. Methods One hundred and forty eight patients from January 1999 to January 2006 were divided into 4 groups according to Society for Fetal Urology (SFU) classification. The follow-up observation and treatments were retrospectively analyzed. Results Forty-one patients in Grade-1 group had undergone follow-up for about 1 year without aggravation, who were not necessary to undergo operation. But 12 of 49 patients in Grade-2 group who had undergone follow-up for 3 to 6 months had to undergo operations because of aggravation of the hydronephrosis. Others in this group were followed up. Thirty one cases in Grade-3 group and 27 cases in Grade-4 group were operated on after diagnosis was identified, who recovered well All cases were followed up by the ultrasonography at 1, 3, 6 and 12 months after operations. No disassociation between calices renales and pelvis renales was detected. Conclusions The operation will be needed in patients with grade 2 or higher of SFU classification. The excellent results can be gained in patients with hydronephrosis detected before birth once the rational treatment gave to them based on SFU classification.