孕晚期胎儿重度肾盂扩张的孕期检测与预后相关性分析

发布时间：2018-07-11 12:31

本文选题：胎儿 + 肾盂扩张　；参考：《青岛大学》2017年硕士论文

【摘要】：目的:通过产前超声诊断、检测、分析孕晚期胎儿重度肾盂扩张的相关指标,以评价患儿的预后及转归情况。方法:本临床研究选择2015年12月至2016年12月于本院就诊进行产前超声检查发现胎儿孕晚期患有重度肾盂扩张的孕妇30例(39只患肾),其中患有单侧重度肾盂扩张的胎儿21例,双侧重度肾盂扩张的胎儿9例。本临床研究将胎儿的肾盂前后径分离程度(Anteroposterior diameter,APD)、肾实质厚度(renal parenchymathickness,RPT)、肾动脉阻力指数(resistance index,RI)、肾动脉搏动指数(Pulsation index,PI)、肾动脉的收缩期峰值流速(PSV)/舒张末期流速(EDV)比值(S/D)及新生儿的肾功能(renal function,RF)等因素作为检查指标,对这部分胎儿出生后的转归情况进行随访研究分析。要求对所选择的全部病例在产前首次确诊为重度肾盂扩张后2周、1个月、6个月及产前和分娩后5-7天进行多普勒超声复查,对出生后仍患有肾盂扩张的患儿每隔3个月随访一次,并复查彩色多普勒超声、泌尿系统造影或MRI及肾功能检查,分别记录APD、RPT、肾动脉RI、肾动脉PI及肾动脉S/D比值的变化情况,定期检测患儿的肾功能,最长随访时间为1年。结果:(1)在30例孕晚期患有重度肾盂扩张的胎儿中有25例活产新生儿和5例引产胎儿;其中,在25例活产新生儿中有8例患儿随访至产后1年时复查超声发现肾盂扩张明显减轻或未见明显变化,均采取保守治疗;有3例患儿随访至产后1年时复查超声发现肾盂扩张消失;有14例患儿随访至产后1年时复查超声发现肾盂扩张呈进行性加重,均行手术治疗。余5例均在产前行引产术终止妊娠,在引产的病例中仅1例引产前进行了羊水染色体核型的分析,结果证实为18-三体综合征。(2)将孕晚期患有重度肾盂扩张的25例活产新生儿按照其出生后的预后转归情况分为III组:I组:产后肾盂扩张消失组,II组:产后肾盂扩张减轻或无变化组;III组:产后肾盂扩张加重组。随访结果表明:各组之间的妊娠结局及肾动脉RI值随访的结果存在显著性差异,具有统计学意义(F_(肾动脉RI)=13.14,P0.05);结果显示随着胎儿肾盂扩张严重程度的进行性增加,其相应的肾动脉RI也会增加。而各组之间的妊娠结局与肾动脉PI值及肾动脉S/D比值随访结果的比较均无统计学意义(F肾动脉PI=0.3012,F肾动脉S/D比值=0.3073,P均0.05)。各组之间的妊娠结局与APD、RPT的随访结果比较均具有显著性差异,均具有统计学意义(FAPD=0.3012,FRPT=0.743,P均0.05)。结果显示随着胎儿肾盂扩张严重程度的进行性加重,其出生后的预后情况就会越差。研究发现孕晚期重度肾盂扩张胎儿的APD的平均范围约2.42cm;RPT的平均厚度约0.27cm;肾动脉RI的平均范围约0.85。(3)本研究将胎儿产后肾盂扩张减轻或无变化组与产后肾盂扩张加重组进行肾动脉RI值与APD之间的相关性分析,发现其相关值r=0.4898,P0.05,两组差异有统计学意义,两者存在低度正相关性。(4)本研究发现孕晚期患有单侧与双侧重度肾盂扩张的胎儿在妊娠结局方面的比较,差异具有统计学意义(χ2=19.96,P0.05)。本研究发现不同性别的孕晚期重度肾盂扩张胎儿在妊娠结局方面的比较,差异无统计学意义(χ2=0.21,P0.05)。结论:(1)孕晚期患有重度肾盂扩张胎儿的预后与APD、RPT、肾动脉RI大小以及是否双侧均合并肾盂扩张等有一定的关系。(2)对于孕晚期APD2.42cm、RPT0.27cm、肾动脉RI值0.85的胎儿,在临床上应重点加强对其的产前超声诊断和监测,必要时选择合适的孕周尽早终止妊娠。(3)在产后随访观察的过程中若发现胎儿的肾盂扩张未见明显缓解或呈进行性加重趋势时,应高度怀疑尿路系统是否存在梗阻性的病变,警惕患儿的肾功是否受损,因为孕晚期患有重度肾盂扩张的胎儿大部分具有病理性梗阻性的积水症状,需尽早进行手术治疗才能缓解或消退。
[Abstract]:Objective: To evaluate the prognosis and prognosis of severe renal pelvis dilatation in the late pregnancy by prenatal ultrasound diagnosis, to evaluate the prognosis and prognosis of the children. Methods: 30 cases of pregnant women with severe renal pelvis dilatation in the late fetal pregnancy (39 patients with renal pelvis) were selected from December 2015 to December 2016 in our hospital. Among them, 21 cases with unilateral severe pyelonephrosis and 9 cases of bilateral severe pyelonephrosis, 9 cases of fetal renal pelvis separation (Anteroposterior diameter, APD), renal parenchyma thickness (renal parenchymathickness, RPT), renal artery resistance index (resistance index, RI), renal artery pulsation index (Pulsation I). Ndex, PI), the renal artery systolic peak velocity (PSV) / end diastolic flow rate (EDV) ratio (S/D) and neonatal renal function (renal function, RF) as a test index, follow up and study the outcome of this part of the fetus after birth. The first diagnosis of all cases in the prenatal period is 2 after the severe renal pelvis dilation. Weeks, 1 months, 6 months, and 5-7 days after birth and 5-7 days after birth, Doppler ultrasonography was conducted to follow up every 3 months for children who were still suffering from pyelonephrosis, and rechecked color Doppler ultrasound, urology or MRI and renal function examination. The changes of APD, RPT, renal artery RI, renal artery PI and the S/D ratio of renal artery were determined respectively. The longest follow-up time was 1 years. Results: (1) in 30 cases with severe renal pelvis dilatation in 30 cases, there were 25 live births and 5 induced aborted fetus. Among them, 8 of the 25 live births were followed up to 1 years postpartum. Conservative treatment was taken; 3 cases were followed up to 1 years postpartum, and the renal pelvis dilatation was found to disappear. 14 cases were followed up to 1 years postpartum to find that the renal pelvis dilatation was progressively aggravated. All the 5 cases were induced by induction of labor before birth. Only 1 cases in the cases of induced labor had amniotic fluid chromosomes before induction of labor. Karyotype analysis proved to be 18- trisomy syndrome. (2) 25 newborns with severe renal pelvis dilatation in the late pregnancy were divided into group III according to the prognosis of their postnatal prognosis: group I: postpartum pyelonephrosis disappearance group, group II: postpartum pyelonephrosis relieving or non change group; III group: postpartum pyelonephrosis and reconstitution. Follow up results showed: There were significant differences in the outcome of pregnancy and RI value of renal artery between each group, which was statistically significant (F_ (renal artery RI) =13.14, P0.05). The results showed that the corresponding renal artery RI increased with the progressive increase of fetal renal pelvis dilatation, and the pregnancy outcome and PI value of renal artery and renal artery S/D between each group. The results of ratio follow-up were not statistically significant (F renal artery PI=0.3012, F renal artery S/D ratio =0.3073, P 0.05). The pregnancy outcomes in each group were significantly different from those of APD, RPT, all with statistical significance (FAPD=0.3012, FRPT=0.743, P, 0.05). The results showed the severity of fetal renal pelvis dilation. Progressively worse, the worse the prognosis after birth. The study found that the average range of APD in the late trimester severe pyelonephrosis fetus was about 2.42cm, the average thickness of RPT was about 0.27cm, and the average range of RI of renal artery was about 0.85. (3). The correlation analysis between RI and APD found that the correlation value r=0.4898, P0.05, two groups were statistically significant, and there was a low positive correlation between the two. (4) this study found that the difference in pregnancy outcome of the fetus with unilateral and bilateral severe renal pelvis dilatation in the late pregnancy was statistically significant (x 2=19.96, P0.05). The findings of this study were found. There was no significant difference in pregnancy outcome between different sexes in the late pregnancy with severe pyelonephrosis fetus (x 2=0.21, P0.05). Conclusion: (1) the prognosis of severe renal pelvis dilatation in the late pregnancy was related to APD, RPT, the size of renal artery RI and bilateral dilatation of renal pelvis. (2) APD2.42cm, RPT0 in the late trimester of pregnancy, RPT0 .27cm, with a RI value of 0.85 of the renal artery, we should focus on the prenatal diagnosis and monitoring of the prenatal ultrasound, and select the appropriate gestational weeks to terminate the pregnancy as necessary. (3) if the fetal renal pelvis expansion is not obviously relieved or progressively aggravated during the postpartum follow-up, it should be highly doubted whether the urinary system is stored or not. In the obstructive disease, be aware of whether the children's renal function is damaged, because most of the fetus with severe pyelonephrosis in the late pregnancy has the symptoms of pathological obstructive hydrops, it is necessary to perform surgical treatment as early as possible to alleviate or fade.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R714.5

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