摘要目的 探讨胎儿期肾积水的预后及治疗.方法 回顾性分析1988年1月至2010年1月在我院门诊行产前检查发现单侧肾积水并在生后检查确诊为肾积水的692例患儿的临床资料.随访期1 -22年(平均142个月).所有患儿生后常规随访,行超声、肾动态显像,并根据胎儿泌尿学会的分级系统进行评估和分类.结果 所有Ⅰ度肾积水,87％(155例)的Ⅱ度肾积水,30％(39例)Ⅲ度肾积水患儿的病情稳定.13％(23例)的Ⅱ度肾积水,70％(92例)的Ⅲ度肾积水和所有的Ⅳ度肾积水患儿接受了外科干预.107例患儿(延迟手术组)因其分肾功能(differentialrena[function,DRF)降低至＜40％而接受手术,93例患儿(早期手术组)的DRF＞40％,但因其肾积水程度进展或无改善并且肾动态显像显示核素清除率不良丽接受手术干预.早期手术纽患儿术后DRF和肾盂深度/肾皮质厚度比值(C/P ratio)(45.8％±0.7％；0.7±0.3)均较术前(42.7％±2.3％；2.0±0.8)改善,延迟手术组患儿术后DRF和c/p比(38.4％±2.6％；1.3±0.5)也均较术前(36.4％±3.3％；2.4±0.8)明显改善(P＜0.05).术后,早期手术组患儿的DRF情况优于延迟手术组.患儿的DRF值在术后第一年(48.8％±4.3％)改善最明显,并在其后逐渐变得稳定.c/P比在术前和术后都与DRF呈负相关(术前:r=-0.26,P=0.01;术后:r=-0.62,P=0.001).结论 所有Ⅰ度肾积水和大部分Ⅱ度肾积水预后相对良好并不需外科干预.术后尽管初始DRF＜40％患儿的DRF改善更多,但减少的DRF并不能恢复到恶化前的水平.对于Ⅲ～Ⅳ度肾积水,在短期严格的临床观察后早期行手术治疗有利于保存其肾功能.

abstractsObjective To investigate the outcome and treatment of neonates bom with isolated unilateral hydronephrosis diagnosed antenatally.Methods We retrospectively reviewed the casenotes of 692 children (541males and 151 females) between january 1988 and January 2010,who had been diagnosed antenatally with isolated,unilateral hydronephrosis and the diagnosis was subsequently confirmed posmatally.The follow up time was 12 months - 22 years (mean 142 months).All patients were followed up with ultrasonography and dynamic renal imaging.Hydronephrosis was assessed and classified according to the Society of Fetal Urology (SFU) grading system.Results Stabilization occurred in all children with grade 1 hydronephrosis,in 87％ of children (155) with grade 2 hydronephrosis,and in 30％ of children (39) with grade 3 hydronephrosis.However,13％ of children (23) with grade 2 hydronephrosis,70％ of children (92) with grade 3 hydronephrosis,and 100％ of children with grade 4 hydronephrosis received surgical intervention according to our pre - detemfined criteria.107 patients (late pyeloplasty group) were treated due to a reduction in the differential renal function (DRF) to ＜40％,and 93 children (early pyeloplasty group) underwent surgery because of worsening hydronephrosis grades or failure to improve and had poor radiotracer clearance.In the early pyeloplasty groups,significant improvements were noted between postoperation and preoperation with respect to the DRF (45.8 ± 1.7％; 42.7 ± 2/％) and the ratio of the depth of the calyces to the thickness of the parenchyrna (C/P ratio) (0.7 ± 0.3; 2.0 ± 0.8,P＜0.05).The same results were seen in the late pyeloplasty group with respect to the DRF (38.4 ± 2.6％ ; 36.4 ± 3.3％ ) and C/P ratio ( 1.3 ±0.5; 2.4 ± 0.8,P＜0.05).The DRF was better in the early pyeloplasty group than the late pyeloplasty group.The improvement in DRF was significant during the first year post- operatively(48.8 ±4.3％) and became stable thereafter.The C/P ratio was inversely correlated with the DRF in the patients before and after pyeloplasty (r =- 0.26,P =0.01 ; and r =- 0.62,P =0.001,respectively).Conclusions All infants with SFU- 1 and most infants with SFU - 2 hydronephrosis do not need an invasive procedure.Although greater improvement occurred in patients with an initial DRF＜40％,the reduced DRF did not recover to the pre- deterioration level post- operatively.Earlier surgical intervention after a short period of strict clinical surveillance is beneficial for preserving renal function in patients with persistent SFU - 3 or SFU - 4 hydronephrosis.