Martín-Crespo R, Luque Mialdea R, Rodríguez Alarcón J, Pais E, Cebrian J, Fernández A, Moreno L, Carrero C
Servicio de Cirugía Pediátrica, Hospital Virgen de la Salud, Complejo Hospitalario de Toledo.
Cir Pediatr. 2007 Apr;20(2):75-8.
Retroperitoneoscopy has shown that US involution is not synonymous with complete regression of the dysplastic renal parenchyma in US-involuted multicystic dysplastic kidney (MCDK). The objective is to analyze the meaning of this results.
16 patients (nine girls and seven boys) with unilateral MCDK that showed complete involution on ultrasonography, underwent prospectively a retroperitoneoscopic approach. US showed complete cysts involution at the mean age of 10 months (ranging from five to 22 months). All patients underwent a retroperitoneoscopic approach after US involution of the MCDK. The mean age of retroperitoneoscopy was 36 months (ranging from eight to 56 months).
The retroperitoneoscopic approach revealed persistence of dysplastic renal tissue in 100% of the patients. The mean lenght of the renal renmant was 2 cm (ranging from 1 and 3.5 cm). All patients had a mean length of stay of less than 24 hours. Anatomo-pathological study of the samples showed a wide spectrum of dysplastic renal tissue and the absence of preneoplastic cells.
Ultrasonography is our method of choice to follow up MCDK until cyst involution takes place. The presence of a dysplastic renal remnant which is not visible on US, requires an appropriate long-term follow up to screen for the growth of tumors. In our experience, retroperitoneoscopy allows the diagnosis and treatment of the displastic renal renmant in the same minimally invasive ambulatory procedure, avoiding long-term development of tumors. Overall, it is our responsibility to sufficiently inform to the family about the persistence of dysplastic renal remnant to facilitate their decision about the best treatment for their child.
后腹腔镜检查显示，在超声消退的多囊性发育不良肾（MCDK）中，超声消退并不等同于发育异常的肾实质完全消退。目的是分析该结果的意义。
16例单侧MCDK患者（9例女孩和7例男孩），超声显示囊肿完全消退，前瞻性地接受了后腹腔镜检查。超声显示囊肿在平均10个月龄时完全消退（范围为5至22个月）。所有患者在MCDK超声消退后均接受了后腹腔镜检查。后腹腔镜检查的平均年龄为36个月（范围为8至56个月）。
后腹腔镜检查显示100%的患者存在发育异常的肾组织。肾残余的平均长度为2厘米（范围为1至3.5厘米）。所有患者的平均住院时间均少于24小时。样本的解剖病理学研究显示发育异常的肾组织范围广泛，且无肿瘤前体细胞。
超声是我们随访MCDK直至囊肿消退的首选方法。存在超声不可见的发育异常的肾残余需要进行适当的长期随访以筛查肿瘤生长。根据我们的经验，后腹腔镜检查可在同一项微创门诊手术中诊断和治疗发育异常的肾残余，避免肿瘤的长期发展。总体而言，我们有责任充分告知家属发育异常的肾残余的持续存在情况，以便他们为孩子做出最佳治疗决策。
