摘要目的 分析单侧肾积水患儿手术前后患肾功能及形态的变化,探讨影响肾功能及形态恢复的相关因素,为手术时机的选择提供依据.方法 回顾性分析我院2009年1月至2014年6月174例行单侧离断式肾盂成形术治疗的肾盂输尿管连接处梗阻致单侧肾积水患儿的临床资料,手术年龄1个月～l4岁,平均46.5个月.按术前分肾功能(DRF)及手术年龄分别分组:Ⅰ组(DRF≥40％)99例,Ⅱ组(DRF 30％ ～ 40％) 29例,Ⅲ组(DRF＜30％) 46例;A组(1～3个月)52例,B组(3个月～3岁)44例,C组(3～6岁)31例,D组(＞6岁)47例.结果 174例患儿中7例出现术后并发症,泌尿系感染6例,肾萎缩1例.术后随访6～81个月,平均27.8个月.Ⅰ组患儿术后肾功能有效保存(DRF 48.46％±4.80％ vs.50.78％±5.45％,P＜0.01),其术后肾脏形态恢复与手术年龄呈负相关(r=-0.374,P＜0.01),且1～3个月组患儿肾脏形态恢复最显著.Ⅱ组患儿术后肾功能改善明显且多数能恢复正常(DRF 35.18％±2.95％ vs.43.91％±6.89％,P＜0.0l).Ⅲ组患儿术后肾功能改善显著且仅少数能恢复正常(DRF 20.70％±6.90％ vs.33.78％±12.49％,P＜0.01),其中l～3个月组患儿术后肾功能改善最显著.肾脏形态恢复与肾功能恢复相似,Ⅰ组、Ⅱ组和Ⅲ组患肾术后美国胎儿泌尿外科学会分度(SFU)降至低于SFU-2度的平均时间分别为6个月、24个月和＞24个月;且随着随访时间的延长肾脏形态逐渐改善(P＜0.01).结论 大多数患儿术后肾功能及形态较术前改善;患肾术前分肾功能影响其术后肾功能及形态的恢复;适时早期予以手术治疗有利于术后患肾分肾功能及形态的恢复.

abstractsObjective To analyze the factors associated with the outcome of pyeloplasty in term of renal function and morphology improvement in children with unilateral ureteropelvic junction obstruction,in order to provide clinical evidence for the treatment of hydronephrosis in children.Methods Clinical data of 174 children who underwent unilateral dismembered pyeloplasty from January 2009 to June 2014 were retrospectively studied.Differential changes in renal function and renal morphology after pyeloplasty were assessed by serial renal scan and ultrasound.On the basis of preoperative split DRF,these patients were divided into three groups:group Ⅰ with DRF ≥40％ (n =99),group Ⅱ with DRF 30％-40％ (n =29) and group Ⅲwith DRF ＜ 30％ (n =46).According to their age at surgery,the children were divided into four groups,including group A aged 1-3 months (n =52),group B aged 3 months-3 years (n =44),groupCaged3-6years (n =37),and group D aged more than 6 years (n =41).Results Inall 174 children,postoperative complication occurred in 7 cases,including urinary tract infection in 6 cases and renal atrophy in 1 case.A significant improvement of both function and morphology was confirmed in most patients (P ＜ 0.01).Patients in group Ⅰ showed stable renal function after operation(DRF 48.46％ ±4.80％ vs.50.78％ ± 5.45％,P ＜ 0.01),of them who underwent pyeloplasty at 1-3 months of age showed the best obvious recovery of renal morphology.Renal function of patients in group Ⅱ recovered obviously and most of them reached to the initial values (DRF 35.18％ ± 2.95％ vs.43.91％ ± 6.89％,P ＜ 0.01).While renal function of patients in group Ⅲ recovered significantly after surgery,most of them failed to restore the initial values(DRF 20.70％ ± 6.90％ vs.33.78％ ± 12.49％,P ＜ 0.01),and among them,the aged 1-3 months group possessed the best recovery.Moreover,the morphological improvement was similar to the functional improvement.The time for hydronephrosis recovered to less than Grade 2 of Society for Fetal Urology(SFU)was 6,24 and over 24 months respectively in group Ⅰ,Ⅱ and Ⅲll,and the renal morphology gradually improved with the increasing duration of follow-up.Conclusions The renal function and morphology of most patients improved significantly after pyeloplasty.Recovery of renal function and morphology after surgery was significantly correlated with the preoperative DRF.Early surgical intervention may improve the function and morphology recovery of the involved renal unit.