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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0.3～1.0 cm 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1.1～1.8 cm 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1.5～3.3 cm 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1.5～7.2 cm 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。
Objective To investigate the relationship between fetal hydronephrosis different grading and anteroposterior diameter and its prognosis and to propose a reasonable plan for observation and clinical treatment during pregnancy. Methods Totally 226 pregnant women with obstetric hydronephrosis were enrolled in obstetrics and gynecology clinic of our hospital. The gestational weeks of ultrasound examination were 20-40 weeks. The morphology and size of fetal renal pelvis, The thickness, to grading, regular ultrasound review and follow-up postpartum outcomes. Results Grade I hydronephrosis in 143 cases of 186 kidney, the anterior and posterior renal pelvis in the 0.3 ~ 1.0 cm between the child quickly dissipated, the prognosis is good; grade hydronephrosis in 47 cases of 52 cases of renal, renal pelvis Before and after the diameter of 1.1 ~ 1.8 cm between the majority of post-natal relief gradually subsided, only a small part (about 3.9%) with gestational weeks increased gradually heavier, after surgery required surgery. Ⅲ grade hydronephrosis fetus a total of 10 cases of 10 kidneys, the anterior and posterior renal pelvis in between 1.5 ~ 3.3 cm, about 70% of life before and after the trend were aggravated by surgery, grade IV hydronephrosis fetus a total of 8 cases 11 Kidney, the anterior and posterior renal pelvis in the 1.5 ~ 7.2 cm, after surgery are required. Conclusions Grade I hydronephrosis is generally not necessary for follow-up monitoring. Pre-and post-nodular hydronephrosis of grade II or higher should be examined regularly by ultrasound. Fetal hydronephrosis should be evaluated by anterior and posterior renal pelvis and grading. .