Song Cheryn, Park Hongjoo, Park Sungchan, Moon Kyung Hyun, Kim Kun Suk
Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, and Ulsan University Hospital, Ulsan, Korea.
BJU Int. 2007 Jun;99(6):1483-6. doi: 10.1111/j.1464-410X.2007.06774.x.
To investigate changes in the differential renal function (DRF) before and after pyeloplasty in renal units with unilateral pelvi-ureteric junction obstruction (PUJO) with supranormal function, and to evaluate the clinical significance.
We reviewed the medical and radiographic records of 29 children (26 boys and three girls) with unilateral PUJO with a DRF (estimated by (99m)Tc-mercaptoacetyltriglycine renal scintigraphy) of >/= 50% in the affected renal unit, who had pyeloplasty and were followed for >1 year after surgery. Patients were divided into two groups according to the degree of change in their DRF to compare the clinical variables, anteroposterior pelvic diameter and parenchymal thickness measured by renal ultrasonography. The mean (range) follow-up after pyeloplasty was 35 (12-89) months.
After pyeloplasty, although the mean DRF reduced from 53.8% to 51.4%, in seven (24%) patients the DRF decreased significantly (>5%) while most (76%) showed a change of </= 5% of the preoperative function, or further improvement. In the seven patients with a DRF of >/= 55% before surgery, the DRF afterward was >55% in four and 50-55% in one. Between those with and with no significant reduction in DRF, only the preoperative renal parenchymal thickness differed significantly (2.78 vs 5.00 mm, P = 0.006).
Supranormal DRF exists and represents the true split function of the affected renal unit in patients with adequate renal parenchyma; these units maintained the supranormal function after pyeloplasty. Parenchymal thickness might be useful to differentiate between the true and false estimates and predict surgical outcome before surgery.
研究单侧肾盂输尿管连接部梗阻（PUJO）且肾功能超常的肾单位在肾盂成形术前、后的分肾功能（DRF）变化，并评估其临床意义。
我们回顾了29例单侧PUJO患儿（26例男孩，3例女孩）的医学及影像学记录，这些患儿患侧肾单位的DRF（通过（99m）锝-巯基乙酰三甘氨酸肾闪烁扫描估算）≥50%，均接受了肾盂成形术，术后随访超过1年。根据DRF的变化程度将患者分为两组，比较临床变量、通过肾脏超声测量的肾盂前后径和实质厚度。肾盂成形术后的平均（范围）随访时间为35（12 - 89）个月。
肾盂成形术后，尽管平均DRF从53.8%降至51.4%，但7例（24%）患者的DRF显著下降（>5%），而大多数（76%）患者的DRF变化≤术前功能的5%，或进一步改善。在术前DRF≥55%的7例患者中，术后4例的DRF>55%，1例为50 - 55%。在DRF有显著降低和无显著降低的患者之间，仅术前肾实质厚度有显著差异（2.78 vs 5.00 mm，P = 0.006）。
超常DRF存在，代表了肾实质足够的患者患侧肾单位的真实分肾功能；这些肾单位在肾盂成形术后维持了超常功能。实质厚度可能有助于在术前区分真实和虚假的评估，并预测手术结果。
