Tsai Jeng-Daw, Huang Fu-Yuan, Lin Chun-Chen, Tsai Tsuen-Chiuan, Lee Hung-Chang, Sheu Jin-Cherng, Chang Pei-Yeh
Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan.
Pediatrics. 2006 Jan;117(1):139-46. doi: 10.1542/peds.2005-0583.
We sought to assess the clinical and imaging findings in intermittent hydronephrosis secondary to ureteropelvic junction obstruction, with particular emphasis on the characteristic ultrasonographic findings.
This prospective, longitudinal, observational study included all children who had intermittent ureteropelvic junction obstruction and presented with abdominal pain over 6 years. Renal ultrasound was used as an initial screening tool to detect intermittent hydronephrosis. Renal ultrasonography was repeated every 1 to 2 days to record serial changes from the symptomatic to the asymptomatic stage. Their clinical manifestations and imaging findings were studied.
Eighteen patients (14 boys, 4 girls) were studied. Most had sharp pain that began acutely and typically lasted for <2 days. Most of the children (16 of 18) had nausea and vomiting that accompanied the pain. The acute episode generally resolved spontaneously and was followed by a pain-free interval that ranged from days to months. Factors that predisposed to an attack included increased water intake, vigorous exercise, or bladder distention. All patients had clearly demonstrable obstruction of the renal pelvis during an acute attack, a finding that diminished or resolved during the symptom-free intervals. During convalescence, all patients had renal pelvic wall thickening on ultrasonography. This finding appeared on the second or third day after a painful episode subsided, persisted for 6 to 9 days, and then disappeared in the symptom-free stage. Pyeloplasty was performed in 17 patients, none of whom had recurrent pain on follow-up. Extrinsic obstructions were found in 9 patients.
The keys to diagnosis are awareness of the syndrome, a detailed history, and immediate and serial imaging studies during painful crises. A thickened renal pelvic wall during convalescence is an important ultrasonic sign of intermittent hydronephrosis.
我们试图评估继发于肾盂输尿管连接处梗阻的间歇性肾积水的临床和影像学表现，尤其着重于特征性超声表现。
这项前瞻性、纵向、观察性研究纳入了所有在6年期间患有间歇性肾盂输尿管连接处梗阻并出现腹痛的儿童。肾脏超声被用作检测间歇性肾积水的初始筛查工具。每1至2天重复进行肾脏超声检查，以记录从症状期到无症状期的系列变化。对他们的临床表现和影像学表现进行研究。
研究了18例患者（14例男孩，4例女孩）。大多数患者有急性起病的剧痛，通常持续时间<2天。大多数儿童（18例中的16例）伴有疼痛的恶心和呕吐。急性发作通常会自行缓解，随后是从数天到数月不等的无痛间歇期。诱发发作的因素包括饮水增加、剧烈运动或膀胱扩张。所有患者在急性发作期间肾盂均有明显梗阻，这一表现在无症状间歇期减轻或消失。恢复期所有患者超声检查均有肾盂壁增厚。这一表现出现在疼痛发作消退后的第二天或第三天，持续6至9天，然后在无症状期消失。17例患者接受了肾盂成形术，随访期间均无复发性疼痛。9例患者发现有外在梗阻。
诊断的关键在于认识该综合征、详细的病史以及在疼痛发作时进行即时和系列影像学检查。恢复期肾盂壁增厚是间歇性肾积水的重要超声征象。
