胎儿肾盂扩张的超声诊断和预后的探讨

目的探讨胎儿肾盂扩张积水的超声诊断和预后。方法对孕20~41周的胎儿进行超声检查,共诊断胎儿肾盂扩张30例,按肾盂扩张的程度分3型:A型:单纯肾盂扩张,扩张范围1.0~1.5 cm;B型:肾盂扩张虽在1.5 cm以内,但肾实质扩大;C型:肾盂明显扩张,超过1.5 cm,肾实质变薄。生后随访3 d~9个月。结果共24例胎儿肾脏先后恢复正常,其中A型19例,B型3例,孕末期即恢复正常而未分型2例;有4例婴儿行手术治疗;有2例胎儿行引产。结论胎儿期肾盂积水若仅为肾盂扩张(1.0~1.5 cm)生后积水可消失。若同时伴有肾实质扩大,部分胎儿生后肾积水持续存在。若肾盂扩张>1.5 cm,伴肾实质变薄,生后肾积水均持续存在,需行手术治疗。

The Ultrasound Diagnosis and Prognosis of Fetal Pyelectasis

Objective To investigate the ultrasound diagnosis and prognosis of fetal hydronephrosis.Methods Ultrasonography was used to examine fetus aged 20～41 weeks.Thirty fetus were diagnosed as hydronephrosis and followed-up from 3 days to 9 months after birth.According the degree of hydronephrosis,three types were classified of the cases.Type A: the width of pyelectasis was 1.0～1.5 cm,Type B: the width of pyelectasis was 1.5 cm,and renal cotex become thinning.Type C: the width of pyelectasis is bigger than 1.5 cm and renal cotex become thinning.Results 30 cases were followed-up.Prognosis showed that 24 cases were recovered successively,including 19 type A;3 type B;no type C,Two fetus were recovered in last stage of pregnancy.Four neonates were diagnosed as hydronephrosis after birth,then were treated by operation.Two fetus were induced labor.It is suggested that hydronephrosis might be recovered after birth when fetal pyelectasis was about 1.0 to 1.5 cm in diameter.Conclusion Hydronephrosis maybe found in some neonates in long term with simultaneous cortical dilatation after birth.And all neonates must be examined and treated by operation when fetal pyelectasis was bigger than 1.5 cm and renal cortex become thinning.