Aziz M A, Hossain A Z, Banu T, Karim M S, Islam N, Sultana H, Alam M I, Hanif A, Khan A R
Department of Surgery, BICH & Dhaka Shishu (Children's) Hospital, Dhaka, Bangladesh.
Eur J Pediatr Surg. 2002 Oct;12(5):304-7. doi: 10.1055/s-2002-35956.
To reduce the incidence of nephrectomy or hydronephrosis in children.
From September 1998 to October 2000, we treated 58 patients with hydronephrosis; their ages ranged from 35 days to 11 years (mean age 4 years 7 months). All patients were subjected to a DTPA renogram with split function. In 12 patients (study group), kidney function was less than 10 % (range 0 - 10 %). Initially, nephrostomy was carried out in all 12 patients followed by Anderson-Hyne's pyeloplasty after 4 - 6 weeks. Postoperatively renal USG, urine r/m/e & c/s (routine and microscopic examination and culture and sensitivity test), blood urea, serum creatinine were assessed and DMSA scan and DTPA renogram with split functions were carried out in all patients.
In the study group, all 12 patients showed improvement of renal function (more than 10 %) after nephrostomy and in all of them pyeloplasty was subsequently carried out within 4 - 6 weeks. There were no significant pre-, peri- or postoperative complications.
Contrary to common practice we do not recommend nephrectomy for hydronephrotic kidneys which show < 10 % of renal function on renogram. The renal functional status improves significantly after a preliminary nephrostomy, thus avoiding the need for a straightforward nephrectomy in children along with all the possible long-term effects of a single kidney.
降低儿童肾切除术或肾积水的发生率。
1998年9月至2000年10月，我们治疗了58例肾积水患者；年龄范围为35天至11岁（平均年龄4岁7个月）。所有患者均接受了具有分肾功能的二巯基丁二酸（DTPA）肾图检查。12例患者（研究组）肾功能低于10%（范围0 - 10%）。最初，所有12例患者均进行了肾造瘘术，4 - 6周后进行了安德森-海恩（Anderson-Hyne）肾盂成形术。术后评估肾脏超声、尿常规及镜检、培养及药敏试验、血尿素、血清肌酐，并对所有患者进行二巯基丁二酸（DMSA）扫描和具有分肾功能的DTPA肾图检查。
研究组中，所有12例患者肾造瘘术后肾功能均有改善（超过10%），随后所有患者均在4 - 6周内进行了肾盂成形术。术前、术中和术后均无明显并发症。
与常规做法相反，对于肾图显示肾功能低于10%的肾积水肾脏，我们不建议进行肾切除术。初步肾造瘘术后肾功能状态显著改善，从而避免了儿童直接进行肾切除术及其可能带来的单肾所有长期影响。
