Nouira Faouzi, Sarrai Nadia, Ghorbel Soufiane, Sghair Yacoub Ould Med, Khemakhem Rachid, Chariag Awatef, Jlidi Said, Chaouachi Beji
Department of Paediatric Surgery, children's Hospital, Tunis, Tunisia.
Tunis Med. 2010 Apr;88(4):253-6.
The last decade has witnessed significant refinements in preoperative diagnostic evaluation and an improvement in surgical techniques and postoperative management for paediatric patients. There has been an improvement in our understanding of the natural history of some congenital renal anomalies which has caused some changes in management approach.
To review the indications for nephrectomy in children between 1996 and 2008, at the departement of paediatric surgery, children's hospital in Tunis.
There were 80 nephrectomies. A retrospective review of the patients' notes was performed. The 13-year period was divided into two halves (1996-2000 and 2001-2008) which were then compared.
The total number of nephrectomies per year significantly increased over the period of the study (4, 6 and 8 nephrectomies per year for 1996-2000 and 2001-2008, respectively; P < 0.05), as did the number of nephrectomies for Multicystic dysplastic kidney (MCDK) (zero and 5 for 1996-2000 and 2001-2008, respectively) and wilms'tumour (8.3% and 29,16% for 1996 - 2000 and 2001 - 2008, respectively). Wilms' tumour, vesico-ureteric reflux (VUR) and pelvi-ureteric junction (PUJ) obstruction accounted for more than half of the nephrectomies (80% and 58% for 1996-2000 and 2001-2008, respectively). The proportion of nephrectomies performed for VUR did not change (15% and 12% for 1996-2000 and 2001-2008, respectively) but fewer nephrectomies were performed for pelvi-ureteric junction (PUJ) obstruction in the second half of the study period (44% and 4,16% for 1996-2000 and 2001-2008, respectively ; P < 0.05).
The total number of nephrectomies, including partial nephrectomies, has increased significantly. The decrease in nephrectomies for PUJ obstruction could be accounted for by a more aggressive approach in the management and follow up of prenatally diagnosed hydronephrosis. Of note is that there was no significant change in the proportion of nephrectomies performed for VUR. On the contrary, the proportion of nephrectomies increased for neoplastic lesions and MCDK.
过去十年见证了小儿患者术前诊断评估的显著改进以及手术技术和术后管理的改善。我们对一些先天性肾异常自然病史的理解有所提高，这导致了管理方法的一些变化。
回顾1996年至2008年突尼斯儿童医院小儿外科行肾切除术患儿的手术指征。
共80例肾切除术。对患者病历进行回顾性分析。将13年的时间段分为两个阶段（1996 - 2000年和2001 - 2008年），然后进行比较。
在研究期间，每年肾切除术的总数显著增加（1996 - 2000年每年4例、6例和8例肾切除术，2001 - 2008年分别为每年6例、8例；P < 0.05），多囊性发育不良肾（MCDK）肾切除术的数量也增加（1996 - 2000年为0例，2001 - 2008年为5例），肾母细胞瘤肾切除术的数量也增加（1996 - 2000年为8.3%，2001 - 2008年为29.16%）。肾母细胞瘤、膀胱输尿管反流（VUR）和肾盂输尿管连接部（PUJ）梗阻占肾切除术的一半以上（1996 - 2000年为80%，2001 - 2008年为58%）。因VUR行肾切除术的比例没有变化（1996 - 2000年为15%，2001 - 2008年为12%），但在研究后半期因肾盂输尿管连接部（PUJ）梗阻行肾切除术的数量减少（1996 - 2000年为44%，2001 - 2008年为4.16%；P < 0.05）。
包括部分肾切除术在内的肾切除术总数显著增加。因PUJ梗阻行肾切除术数量的减少可能是由于对产前诊断的肾积水采取了更积极的管理和随访方法。值得注意的是，因VUR行肾切除术的比例没有显著变化。相反，肿瘤性病变和MCDK的肾切除术比例增加。
