胎儿泌尿系畸形的超声随访监测与临床对比观察

目的对孕期超声监测到胎儿泌尿系统畸形者的妊娠结局和患儿以后的肾脏功能进行评估.方法对1993年1月～2003年12月所有产前超声检查怀疑泌尿系先天畸形的患儿进行产前死亡率、产后超声诊断、产后处理、肌酐清除率进行回顾性分析,以评估以后的肾脏功能.结果 74例产前超声怀疑为泌尿系畸形者,18例考虑到泌尿系畸形可能为致命性病变而终止妊娠,15例患儿于产前或产后1个月内死亡.至今存活者,21例肾脏功能良好、5例肾功能欠佳、3例肾功能极差,12例胎儿于出生后超声证实不是畸形,他们的肾功能良好,产前怀疑双侧泌尿系畸形和合并其他相关畸形患儿预后较差.结论产前诊断泌尿系畸形预后依靠特有的异常发现,染色体组型异常、合并其它相关畸形、累及双侧的先天泌尿系畸形预后较差.

Ultrasund Monitoring and Follow-up of Urinary Tract Anomalies and Clinical Observation

Objective We determined the outcome of pregnancy and long-term renal function in cases of sonographically detected fetal urinary tract anomalies (UTAs).Methods This was a retrospective study done at our hospital.All records of prenatal sonographic examinations done between January 1993 and December 2003 These fetuses suspected as with urinary tract anomalies(UTA)were examined for perinatal mortality,postnatal confirmation of sonographic diagnosis,postnatal management,and calculated creatinine clearance to determate the ultimate renal functions.Results Of 74 cases with suspected UTAs,18 pregnacies were terminated because the UTA was considered fatal,and 15 fetuses died perinatally.21 children are alive with good renal functions,5 with moderate renal functions,and 3 poor renal functions.The prenatal diagnosis was not confirmed after birth in 12 children,all of whom are alive with good renal function.The prognosis for prenatally suspected UTA was worse in cases of bilateral involvement and in cases associated with multiple malformation.Conclusions The prognosis of prenatally diagnosed UTAs depends on the specific anomalous findings.The prognosis was poor with abnormal karyotype,other associated malformations,and bilateral involvement.