小儿肾积水肾盂成形术后肾功能提高的因素分析和肾切除术指征的探讨

发布时间：2018-06-02 03:45

本文选题：儿童 + 肾积水　；参考：《复旦大学》2014年硕士论文

【摘要】：研究目的：目前,现有的研究文献对于小儿肾盂输尿管交界处梗阻(UPJO)离断式肾盂成形术后,患肾的分肾功能是否恢复以及哪些因素影响术后分肾功能的提高仍然存在很大的争议。本研究的主要目的是通过对比研究UPJO患儿手术前、后分肾功能的变化,以了解患肾分肾功能是否得到提高,并探讨术前各种因素对肾积水术后分肾功能恢复的影响。资料与方法：回顾性分析了2008年3月至2012年8月期间本院泌尿外科手术的单侧UPJO肾积水患儿,排除孤立肾、双侧肾积水及合并有其它泌尿系统畸形、疾病的病例,所有纳入本研究的患儿均在手术前做过泌尿系统超声检查及利尿性肾动态显像,并且在手术后至少随访过一次利尿性肾动态显像。分析手术前、后分肾功能的变化,并以术后分肾功能增加大于等于5%作为分肾功能好转的参考标准。将手术前患儿性别、月龄分组、积水的左右侧、积水肾的SFU分级及分肾功能(DRF)分级、利尿性肾图曲线类型作为潜在的影响因素,与术后分肾功能是否改善作二分类的Logistic回归分析。所有统计分析均采用IBM SPSS v21统计软件进行处理,以P0.05作为具有统计学意义的标准。结果：共有213例患儿纳入本研究,其中男181例,女32例,术前患儿年龄为1周-148月,平均34.5月。手术后随访DRF由术前32.61%±14.09%增加到40.43%±11.32%,经两样本配对t检验得到p0.05(p=0.000),即术后首次随访分肾功能的变化有统计学意义。以5%变化来判断,仅1例术后分肾功能恶化,102例肾功能稳定,110例肾功能有恢复。术前患儿性别、年龄、积水侧、积水的SFU分级、术前DRF分级以及术前肾图曲线类型作为潜在的影响因素,与术后肾功能是否改善作二项Logistic回归分析,提示术前的分肾功能、肾积水的程度以及手术时的年龄都是影响术后分肾功能恢复的影响因素,而性别、积水的左右侧、术前患肾肾图曲线类型则不是。术后分肾功能并不随时间的延长而持续增长。结论：小儿肾积水手术解除梗阻后,患肾的积水程度和排泄状况都能得到改善,并且积水肾的分肾功能是可以得到提高的,术前的分肾功能、肾积水的程度以及手术时的年龄都是影响术后分肾功能恢复的影响因素,而术后肾功能的改变与患者的性别、积水的左右侧、术前肾脏的排泄梗阻状况以及随访时间无关。研究目的：目前,对小儿肾积水术前分肾功能低于10%的患肾是否行肾切除术存在较大的争议。本研究的主要目的是探讨能否以术前分肾功能小于10%作为肾切除术的指征。并进一步探讨若以术前分肾功能作为参考,重度UPJO肾积水肾切除的指征。资料与方法：回顾性分析了2008年3月至2012年8月期间本院泌尿外科手术的单侧UPJO肾积水患儿,纳入标准同本研究第一部分,且要求术前分肾功能低于40%。根据术前DRF,分为3组,即Ⅰ组：10%≤术前DRF40%,Ⅱ组：5%≤术前DRF10%,Ⅲ:术前DRF5%。分析各组手术前后分肾功能的变化,并以增加5%作为分肾功能好转的标准。采用配对样本t检验,统计分析采用IBM SPSS v21软件进行,以p0.05作为具有统计学意义。结果：共有128例患儿进入本研究,其中男108例,女20例。Ⅰ组、Ⅱ组患儿术后DRF分别由27.50%±7.44%、8.58%±1.38%提高到39.28%±8.34%、26.73%±11.97%,手术前后变化值均有统计学意义(p=0.000),表明肾盂成形术后患肾分肾功能得到明显提高。而Ⅲ组患儿术后DRF由3.89%±0.88%变为3.63%±0.94%,手术前后变化值无统计学意义(p=0.602),表明术后分肾功能没有提高。结论：分肾功能小于10%不能作为小儿肾积水肾切除术的指征,这部分患儿行肾盂成形术后患肾功能有得到提高甚至恢复正常的可能。但若以5%为标准,肾盂成形术后患肾功能未见提高,可以考虑以分肾功能低于5%作为肾切除术的参考标准。
[Abstract]:Research purposes: Currently, there is still a lot of controversy in the current research literature on whether the renal function recovery of the kidney is restored and what factors affect the improvement of renal function after the ureteropelvoplasty (UPJO) in children with ureteropelvic junction obstruction (UPJO). The main purpose of this study is to compare the pre operation and post operation of UPJO children. Changes in the function of the kidney in order to know whether the renal function has been improved or not, and the effect of various factors on the recovery of renal function after hydronephrosis. Data and methods: a retrospective analysis of the unilateral UPJO nephrectomy in the Department of urology from March 2008 to August 2012, the exclusion of isolated kidney, bilateral hydronephrosis and combined treatment, was reviewed. All the cases with other urinary tract malformations and diseases were examined by ultrasound and diuretic dynamic imaging before the operation, and at least one diuretic renal dynamic imaging was followed up at least once after the operation. The changes of renal function before operation were analyzed, and the increase of renal function after operation was equal to 5%. As a reference standard for the improvement of renal function, the sex, the age group, the left and right side of the hydronephrosis, the SFU classification of the hydronephrosis and the classification of the renal function (DRF), the type of diuretic renogram as the potential influencing factor and the two classification of the renal function after the operation were analyzed by Logistic regression analysis. All the statistical analysis used IBM SPSS v21 statistical software was treated with P0.05 as a standard of statistical significance. Results: a total of 213 children were included in this study, including 181 males and 32 females. The age of the pre operation children was 1 weeks -148 months, with an average of 34.5 months. The follow-up DRF was increased to 40.43% + 11.32%, and P0.05 (p=0) was obtained by a two sample paired t test. .000), that is, the changes of renal function after the first follow-up were statistically significant. Judging by 5% changes, only 1 cases were divided into renal function deterioration, 102 cases of renal function stability, 110 cases of renal function recovery. The preoperative sex, age, water side, water accumulation, SFU classification, preoperative DRF classification, and preoperative renal mapping curve type as potential influencing factors, Two Logistic regression analysis was made for the improvement of renal function after operation. It was suggested that the function of the kidneys, the degree of hydronephrosis and the age of the operation were the factors affecting the recovery of the renal function, while the sex, the left and right side of the hydrops, and the type of kidney and kidney graph curve before the operation were not. Conclusion: after the removal of obstruction in children with hydronephrosis, the degree of water accumulation and excretion of the kidney can be improved, and the renal function of the hydronephrosis can be improved. The function of the kidney, the degree of hydronephrosis and the age of the operation are the factors affecting the recovery of the renal function after operation, and the renal function after the operation. The changes are not related to the sex of the patient, the left and right side of the hydrops, the condition of the renal excretion obstruction and the time of follow-up. The purpose of this study is to discuss whether the kidney function is less than 10% of the kidney function before the operation of the nephrectomy. The main purpose of this study is to explore whether the renal function is less than 10% before operation. The indications of nephrectomy. And further discuss the indications of severe UPJO nephrectomy for renal hydronephrosis as a reference. Data and methods: a retrospective analysis of the unilateral UPJO hydronephrosis in the Department of Urology during the period from March 2008 to August 2012 was included in the first part of the same study, and the renal function was required before the operation. Lower than 40%. according to preoperative DRF, divided into 3 groups, i. e. group I: 10% less than DRF40% before operation, group II: 5% < DRF10% before operation, III: before and after operation DRF5%. analysis of renal function changes before and after operation, and increase 5% as the standard of renal function improvement. Using paired sample t test, statistical analysis using IBM SPSS v21 software, P0.05 as a system Results: a total of 128 children were enrolled in this study, including 108 males and 20 females. Group I, the postoperative DRF in group II was 27.50% + 7.44%, 8.58% + 1.38% to 39.28% + 8.34%, 26.73% + 11.97%, and the changes were statistically significant before and after operation (p=0.000). The renal function of renal pelvis after pyeloplasty was obviously improved. In group III, the postoperative DRF changed from 3.89% + 0.88% to 3.63% + 0.94%, and there was no statistical significance before and after operation (p=0.602), indicating that the function of renal function was not improved after operation. Conclusion: the function of renal function less than 10% can not be used as the indication of nephrectomy in children with hydronephrosis, and the renal function of the children after pyeloplasty is improved or even restored. It is often possible. However, if the standard of renal function is not improved after 5% cases of pyeloplasty, the renal function below 5% should be considered as a reference standard for nephrectomy.
【学位授予单位】：复旦大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R726.9

【共引文献】