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目的探讨产前诊断并积极随访及产后早期手术治疗对先天性肾积水患儿预后的影响。方法回顾性分析85例肾盂输尿管连接处狭窄患儿的临床资料,按其是否行产前诊断分为产前组和产后组,对2组患儿术前病情、术中所见大体病理及采用术式、出院前恢复状况及并发症发生率等多项预后参数进行比较,并行统计学分析。结果产前组在术前发生4级以上肾积水、继发肾结石、对侧肾积水与术前并感染及出现肾周黏连、术后并发症发生率等参数与产后组比较,差异均有统计学意义(Pa<0.05)。产前组术后多种抗生素联合使用率高于产后组(P<0.05)。产前组术前肾造瘘,术中所见脓肾,术后三线抗生素使用率,术后带管出院,术中选择肾切除术等参数与产后组比较,差异均无统计学意义(Pa>0.05)。结论 1.产前及产后超声检查和随访非常必要,且有利于临床医师早期检测并判断病情。2.早期手术安全可靠,且在术后初期可达到与大龄儿童相同的临床治愈效果。3.产后早期手术治疗在有效防范先天性肾积水患儿发生严重并发症及不可逆肾脏改变上更有临床意义。
Objective To investigate the effect of prenatal diagnosis, positive follow-up and early postpartum surgical treatment on the prognosis of children with congenital hydronephrosis. Methods A retrospective analysis of 85 cases of ureteropelvic junction stenosis in children with clinical data, according to whether the prenatal diagnosis is divided into prenatal and postpartum groups, two groups of children preoperative condition, intraoperative findings gross pathology and use Surgical procedures, pre-discharge recovery and the incidence of complications such as a number of prognostic parameters were compared statistically statistical analysis. Results Preoperative group occurred more than grade 4 hydronephrosis before surgery, secondary kidney stones, contralateral hydronephrosis and preoperative infection and perinephric adhesions, the incidence of postoperative complications and other parameters compared with the postpartum group, The differences were statistically significant (Pa <0.05). The combined use of multiple antibiotics in the prenatal group was higher than that in the postnatal group (P <0.05). Preoperative group of preoperative nephrostomy, intraoperative pus and see the postoperative three antibiotic use rate, postoperative drainage tube, intraoperative selection of nephrectomy and other parameters compared with the postpartum group, the difference was not statistically significant (Pa > 0.05). Prenatal and postnatal ultrasound examination and follow-up is necessary, and is conducive to clinicians early detection and judgment of the disease. Early surgery is safe and reliable, and in the early postoperative period can reach the same clinical cure with older children. 3. Early postpartum surgical treatment in the prevention of congenital hydronephrosis in children with serious complications and irreversible changes in the more clinical significance.