利尿肾动态显像在单侧肾盂输尿管连接部狭窄患者的手术或保守治疗中的应用

目的：观察单侧肾盂输尿管连接部狭窄（ureteropelvic junction obstruction，UPJO）的患者在接受不同治疗方式后的随访过程中，患肾相对肾功能（relative renal function, RRF）与引流变化情况，分析利尿肾动态显像在UPJO患者临床处置中的应用价值。方法：回顾性分析因单侧UPJO就诊且有随访资料的患者76例，全部患者均进行利尿肾动态显像及临床随访，患者对侧肾功能均正常。观察患肾RRF与引流变化情况，分析在不同的患肾初始RRF（RRFinitial）与梗阻类型中患肾RRF的变化情况。结果：手术治疗组（57例），患肾RRFinitial 为40.81%±12.96%，末次随访RRF（RRFrecent）为44.63%±13.21% (P<0.05)，组中54.00%机械性梗阻患者（27/50）术后引流改善，71.43%非机械性梗阻者（5/7）术后引流无变化。保守治疗组（19例），RRFinitial为46.47%±12.84%，RRFrecent为46.95%±11.86% (P>0.05)，其中10%机械性梗阻者（1/10）引流改善，90%机械性梗阻者（9/10）及全部（9/9）非机械性梗阻者引流无明显变化。保守治疗组中4例患者（4/19）因肾功能恶化行手术治疗。无论手术治疗组或保守治疗组，在不同患肾RRFinitial与梗阻类型中，患肾RRF的变化差异均无统计学意义。结论：利尿肾动态显像可有效应用于UPJO患者的随访和监测，手术治疗可改善患肾RRF与引流情况，但是对于临床症状轻微或者无症状的UPJO患者，只要RRF保持稳定，可采取随访观察的策略。

Efficiency evaluation of diuretic renography in the operative or conservative treatments of unilateral ureteropelvic junction obstruction patients

Objective：To analyze the efficiency of diuretic renography in the management of unilateral ureteropelvic junction obstruction (UPJO) patients, by observing the affected kidney relative renal function (RRF) and drainage in the period of follow-up. Methods:In the study, 76 patients diagnosed as unilateral UPJO were retrospectively collected. Diuretic renography was performed on all the patients initially, and during the period of follow-up. No morphological or functional abnormalities were detected on the contralateral kidney. Changes of affected renal RRF and drainage were observed during the follow-up period. The correlations of initial RRF (RRFinitial) and drainage type with RRF improvement were analyzed.Results:In the operative group (57 cases), the RRFinitial of affected kidney was 40.81%±12.96%, and the RRF in the last follow-up (RRFrecent) was 44.63%±13.21% (P<0.05). Drainage improvements was found in 54.00% of the obstructive patients (27/50), and unchanged in 71.43% of the non-obstructive patients (5/7). In the conservative group (19 cases), the RRFinitial was 46.47%±12.84%, and the RRFrecent was 46.95%±11.86% (P>0.05). One obstructive patient (1/10) was found with improved drainage, and the other 9 obstructive patients (9/10) and all of the non-obstructive patients (9/9) were observed with unchanged drainage. Four patients with deteriorated RRF in the conservative group received surgery. There were no significant differences in the changes of affected renal RRF in different RRFinitial and drainage types in both operative and conservative groups.Conclusion:Diuretic renography could be effectively applied in the follow-up of unilateral UPJO patients. Operation could improve affected kidney’s RRF, and better some patients’ drainage conditions. However, for those patients with no or minor clinical symptoms, conservative management could be accepted if RRF remains stable during the period of follow up.