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目的探讨小儿巨大肾积水保肾治疗方法的选择及提高疗效的方法。方法回顾性分析本院2005年3月-2009年3月行保肾治疗的37例巨大肾积水患儿的临床资料。其中直接行离断式肾盂输尿管成形术20例(直接手术组);先行肾穿刺造瘘引流,造瘘后行离断式肾盂输尿管成形术17例(19侧,造瘘组)。术后随访6个月～4 a,比较2种治疗方法的疗效。造瘘组患儿在造瘘期间,行B超检查并测定患肾肾盂尿清蛋白(Alb)和β2-微球蛋白(β2-MG),观察其患肾功能恢复情况。结果直接手术组患儿中2例因术后肾萎缩切除患肾,腹胀5例,曾有尿路感染2例,伴结石2例,B超检查轻度肾积水6例、中度9例、重度5例(其中2例肾萎缩),肾皮质厚度(5.35±2.00)mm(1～8 mm)。造瘘组患儿均无腹胀、尿路感染,B超检查无肾积水4例(4侧)、轻度积水11例(13侧)、中度2例(2侧),无重度肾积水、结石和肾萎缩患儿。肾皮质厚度(8.30±1.85)mm(6～13 mm)。造瘘后肾缩小,肾皮质变厚,患肾皮质厚度逐渐增加,在1周内最明显,4周后趋于平稳。肾造瘘后,肾盂尿β2-MG水平在4周内恢复正常;肾盂尿Alb水平降低,但造瘘12周后仍未恢复正常。结论造瘘引流后手术较直接手术患儿肾功能恢复好,并发症少,能挽救部分巨大肾积水患肾。巨大肾积水造瘘后,肾小管功能最先恢复,肾小球功能的恢复需更长时间。肾盂尿β2-MG水平可作为监测造瘘期间患肾功能恢复的指标。
Objective To explore the treatment of children with huge hydronephrosis kidney selection and methods to improve efficacy. Methods A retrospective analysis of our hospital from March 2005 -2009 March line 37 cases of kidney hydronephrosis in children with clinical data. Among them, 20 cases were treated with direct ureteralopelvic angioplasty (direct operation group), 17 cases with renal pelvic ureteroplasty (19 cases, fistula group) were performed with renal puncture and fistula drainage. The patients were followed up for 6 months to 4 years. The curative effects of the two treatments were compared. During the period of ostomy, the fistula patients underwent B-mode ultrasonography and renal tubulointerstitial albumin (Alb) and β2-microglobulin (β2-MG) were measured and the recovery of renal function was observed. Results In the direct operation group, 2 cases had renal and abdominal distension due to postoperative renal atrophy. There were 2 cases of urinary tract infection, 2 cases with stones, 6 cases with mild hydronephrosis by B ultrasound and 9 cases with moderate , Severe 5 cases (2 cases of renal atrophy), renal cortex thickness (5.35 ± 2.00) mm (1 ~ 8 mm). There were no bloating and urinary tract infection in the fistula group. There were 4 cases of hydronephrosis on the B-ultrasound, 11 cases of mild hydronephrosis (13 sides), 2 cases of moderate (2 sides), no severe kidney Hydrocephalus, stones and kidney atrophy in children. Renal cortex thickness (8.30 ± 1.85) mm (6 ~ 13 mm). After the fistula renal shrinking, thickening of the renal cortex, increased risk of renal cortical thickness, the most obvious in 1 week, 4 weeks after the tend to be stable. Nephrostomy, renal pelvis and urine β2-MG levels returned to normal within 4 weeks; Alb pelvic urinary level decreased, but did not return to normal after 12 weeks of fistula. Conclusion The drainage of fistula after surgery than the direct operation of children with good recovery of renal function, fewer complications, can save part of the huge hydronephrosis of the kidney. After a huge hydronephrosis, renal tubular function first restored, glomerular function recovery takes longer. Renal pelvic urine β2-MG levels may be used as indicators of renal function recovery during ostomy monitoring.