Arnold A J, Rickwood A M
Department of Paediatric Urology, Royal Liverpool Children's Hospital.
Br J Urol. 1990 Jan;65(1):91-6. doi: 10.1111/j.1464-410x.1990.tb14666.x.
Fifty-six infants with prenatally diagnosed hydronephrosis are reported. In all instances the diagnosis was confirmed postnatally and at renography 45 were obstructed; 38 obstructed kidneys (84%) and all of the non-obstructed kidneys had a differential function exceeding 40% of total function. Latterly we have come to recommend early pyeloplasty only if differential function of a renographically obstructed kidney is less than 40%; 6 early pyeloplasties were performed for this reason; 28 infants (30 renal units) were managed non-operatively and 18 of these (19 renal units) were reassessed renographically. In 11 the obstruction persists. Sonography demonstrated improving hydronephrosis in 8 kidneys with resolution in 5 and no change in 6. Of the other 10 infants (11 renal units), the hydronephrosis has improved in 4, resolved in 1 and remains unchanged in 6. Our experience suggests that neonatal and early pyeloplasty can be restricted to a modest number of infants in whom there is impaired renal function. In cases with normal function the natural history appears essentially benign and does not justify routine pyeloplasty.
报告了56例产前诊断为肾积水的婴儿。所有病例均在出生后得到确诊，肾造影显示45例存在梗阻；38例梗阻性肾脏（84%）以及所有非梗阻性肾脏的分肾功能超过总肾功能的40%。近来我们开始建议，仅当肾造影显示梗阻的肾脏分肾功能低于40%时才进行早期肾盂成形术；因此进行了6例早期肾盂成形术；28例婴儿（30个肾单位）采取非手术治疗，其中18例（19个肾单位）接受了肾造影复查。11例梗阻持续存在。超声检查显示8个肾脏的肾积水有所改善，5个消退，6个无变化。另外10例婴儿（11个肾单位）中，4例肾积水改善，1例消退，6例无变化。我们的经验表明，新生儿期和早期肾盂成形术可局限于少数肾功能受损的婴儿。在功能正常的病例中，其自然病程似乎基本为良性，因此常规肾盂成形术并无必要。
