超声对胎儿肾盂积水的观察及其临床意义

目的 探讨检查胎儿肾盂积水的不同分级及前后径与其预后的关系,为孕期观察及临床处理提出合理方案。方法检查对象来自我院产科门诊被疑为胎儿肾盂积水的孕妇,共226例,超声检查孕周为20-40周;应用二维超声观察、测量胎儿肾盂形态及大小、肾盏变化和肾皮质的厚度,给以分级,定期超声复查并追踪产后结局。结果 Ⅰ级肾盂积水胎儿共143例186只肾,其肾盂前后径在0.3-1．0cm之间,生后很快消退,预后好;Ⅱ级肾盂积水胎儿共47例52只肾,其肾盂前后径在1．1-1．8cm之间,生后大部分缓解渐消退,只有少部分（约3.9％）随孕周增加渐加重,生后需手术治疗。Ⅲ级肾盂积水胎儿共10例10只肾,其肾盂前后径在1．5-3.3cm之间,约70％生前、后均呈加重趋势需手术治疗,Ⅳ级肾盂积水胎儿共8例11只肾,其肾盂前后径在1．5-7．2cm之间,生后均需手术治疗。结论 对Ⅰ级肾盂积水,一般无随访监测的必要;Ⅱ级以上肾盂积水产前、产后需定期超声检查,采用肾盂前后径线和分级联合应用的方法对胎儿肾盂积水进行评估比较合适。

Prenatal ultrasonography for fetus with hydronephrosis

OBJECTIVE: To investigate the relationship between classification and prognosis of hydronephrosis in fetus. METHODS: 226 pregnant women in their pregnant weeks 20 - 40 who were suggested to be with fetuses suffering from hydronephrosis underwent ultrasonography to observe the configuration of the kidneys, form and size of renal pelvis, extent of calyces, and thickness of renal cortex of their fetuses. The ultrasonography was conducted regularly and the outcome after birth was followed up. RESULTS: 143 fetuses (186 kidneys) were diagnosed as with hydronephrosis of grade I with the anteroposterior diameter of the renal pelvis from 0.3 to 1.1 cm that fadeawayed soon after birth with a good prognosis. 47 fetuses (52 kidneys) were diagnosed as with hydronephrosis of grade II with the anteroposterior diameter of the renal pelvis from 1.0 to 1.8 cm, most of which remised gradually after birth, and only about 5% of which became worse along with the time of pregnancy and needed surgery after birth. 10 fetuses (10 kidneys) were diagnosed as with hydronephrosis of grade III with the anteroposterior diameter of the renal pelvis from 1.5 to 3.3 cm about 70% of which showed a tendency to deteriorate along with the time of pregnancy and after birth, and the neonates needed surgery after birth. Eight fetuses (10 kidneys) were diagnosed as with hydronephrosis of grade IV with the anteroposterior diameter of renal pelvis from 1.5 to 7.2 cm that needed surgery after birth. CONCLUSION: Follow-up and monitoring are not necessary for those fetus with hydronephrosis of grade I; however, regular ultrasonography is needed for the those with hydronephrosis of grade II and over.